| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Query the Registry for Juana Mariana Vazquez | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Patient Identifier | ||
| ID Number | 123456 | |
| Assigning Authority | ||
| Namespace ID | MYEHR | |
| ID Type | MR | |
| Patient Identifier | ||
| ID Number | 987633 | |
| Assigning Authority | ||
| Namespace ID | MYIIS | |
| ID Type | SR | |
| Name | Juana Mariana Vazquez | |
| Date of Birth | 11/01/2016 | |
| Sex | Female | |
| Address 1 | ||
| Street | 4345 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | USA | |
| Address Type | L | |
| Mother's Maiden Name | Maria Merida Acosta | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||
| Evaluated Immunization History Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Entering Organization | Shoreline Hospital | |
| Vaccine Group | hepatitis B vaccine, unspecified formulation | |
| Vaccine Administered | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| Refusal Reason | ||
| Date/Time Administration-Start | 11/01/2016 | |
| Date/Time Administration-End | 11/01/2016 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | Jane Carter | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | SH | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Shoreline Pediatrics | |
| Vaccine Group | hepatitis B vaccine, unspecified formulation | |
| Vaccine Administered | hepatitis B vaccine, unspecified formulation | |
| Refusal Reason | ||
| Date/Time Administration-Start | 12/20/2016 | |
| Date/Time Administration-End | 12/20/2016 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | Sandra Molina | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | SP | |
| Street Address | 400 Shoreline Drive | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | hepatitis B vaccine, unspecified formulation | |
| Vaccine Administered | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/20/2017 | |
| Date/Time Administration-End | 05/20/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/22/2017 | |
| Date/Time Administration-End | 05/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| Refusal Reason | ||
| Date/Time Administration-Start | 02/21/2018 | |
| Date/Time Administration-End | 02/21/2018 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 4 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/22/2017 | |
| Date/Time Administration-End | 05/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| Refusal Reason | ||
| Date/Time Administration-Start | 11/21/2017 | |
| Date/Time Administration-End | 11/21/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 4 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | poliovirus vaccine, inactivated | |
| Vaccine Administered | poliovirus vaccine, inactivated | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Arm | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | poliovirus vaccine, inactivated | |
| Vaccine Administered | poliovirus vaccine, inactivated | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Arm | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | pneumococcal conjugate vaccine, 13 valent | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | pneumococcal conjugate vaccine, 13 valent | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | pneumococcal conjugate vaccine, 13 valent | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/22/2017 | |
| Date/Time Administration-End | 05/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | pneumococcal conjugate vaccine, 13 valent | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/11/2018 | |
| Date/Time Administration-End | 01/11/2018 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 4 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | rotavirus, unspecified formulation | |
| Vaccine Administered | rotavirus, live, monovalent vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 1.0 | |
| Administered Units of Measure | mL | |
| Route of Administration | Oral | |
| Administration Site | ||
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | rotavirus, unspecified formulation | |
| Vaccine Administered | rotavirus, live, monovalent vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 1.0 | |
| Administered Units of Measure | mL | |
| Route of Administration | Oral | |
| Administration Site | ||
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/25/2017 | |
| Date/Time Administration-End | 09/25/2017 | |
| Administered Amount | 0.25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| Refusal Reason | ||
| Date/Time Administration-Start | 10/29/2017 | |
| Date/Time Administration-End | 10/29/2017 | |
| Administered Amount | 0.25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza, injectable, quadrivalent, preservative free, pediatric | |
| Refusal Reason | ||
| Date/Time Administration-Start | 10/02/2018 | |
| Date/Time Administration-End | 10/02/2018 | |
| Administered Amount | .25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | ||
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | ||
| Number of Doses in Series | ||
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| Refusal Reason | ||
| Date/Time Administration-Start | 11/04/2019 | |
| Date/Time Administration-End | 11/04/2019 | |
| Administered Amount | 0.25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | ||
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | ||
| Number of Doses in Series | ||
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hep A, unspecified formulation | |
| Vaccine Administered | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| Refusal Reason | ||
| Date/Time Administration-Start | 11/23/2017 | |
| Date/Time Administration-End | 11/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Deltoid | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | ||
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hep A, unspecified formulation | |
| Vaccine Administered | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/23/2018 | |
| Date/Time Administration-End | 05/23/2018 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | ||
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Shoreline Pediatrics | |
| Vaccine Group | MMR | |
| Vaccine Administered | measles, mumps, rubella virus vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 08/22/2017 | |
| Date/Time Administration-End | 08/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | Sandra Molina | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | SP | |
| Street Address | 400 Shoreline Drive | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | NO | |
| Validity Reason | Early | |
| Completion Status* | Complete | |
| Dose Number in Series | ||
| Number of Doses in Series | ||
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | MMR | |
| Vaccine Administered | measles, mumps, rubella virus vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/22/2020 | |
| Date/Time Administration-End | 09/22/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Arm | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Varicella virus vaccine | |
| Vaccine Administered | varicella virus vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 12/15/2018 | |
| Date/Time Administration-End | 12/15/2018 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Right Arm | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||
| Immunization Forecast | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Vaccine Group | IPV | |
| Vaccine Due Date | 04/29/2017 | |
| Earliest Date to Give | 04/29/2017 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 04/30/2018 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Due Date | 09/01/2021 | |
| Earliest Date to Give | 09/01/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 10/31/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | MMR | |
| Vaccine Due Date | 10/31/2020 | |
| Earliest Date to Give | 10/31/2020 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 10/31/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Varicella | |
| Vaccine Due Date | 10/31/2020 | |
| Earliest Date to Give | 10/31/2020 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 10/31/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Description |
|---|
If the EHR does not already flag the first MMR as invalid, the provider updates the first MMR to indicate it is "invalid" as it was given too early (as notified by the registry). |
| Comments |
|---|
If the EHR already recognizes the dose as invalid, then this step may be skipped. |
| Pre-condition |
|---|
Initial Data Load - Step 2: Enter Initial Immunization Data for Juana Mariana Vazquez: Immunizations from practice. |
| Post-Condition |
|---|
MMR status for the first MMR dose is set to invalid. |
| Test Objectives |
|---|
dose validity is an important aspect of: View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. |
| Evaluation Criteria |
|---|
Evaluation Criteria: The vendor is able to record that the first MMR vaccination dose is invalid with a reason that it was given too early, and therefore the dose administered on 9/22/2020 should indicated dose '1'. |
| Notes |
|---|
In the steps that follow, the MMR returned from the registry will be imported and the vaccine forecasting steps will further verify the correct documentation of the dose that will be imported from the registry as dose '1'. |
| Description |
|---|
The physician accesses the record for Juana Mariana Vazquez and: - Displays the registry forecast as returned by the immunization registry. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR. |
| Post-Condition |
|---|
Immunization Forecast returned from the registry has been displayed to the user. |
| Test Objectives |
|---|
View Immunization Forecast: The EHR or other clinical software system provides a view of the immunization forecast provided by the IIS. The display includes the recommended vaccines and their associated dates (e.g., earliest, recommended, past due, latest) for each vaccine included in the forecast. |
| Evaluation Criteria |
|---|
1. The EHR displays the information returned from the Immunization Registry according to the Juror Document. 2. Verify that all forecast vaccines and dates returned by the registry are displayed to the user. |
| Notes |
|---|
The verification content for the vaccine forecast also is part of the juror document in the prior step 3: View and Compare response to request for vaccination history for Juana Mariana Vazquez. The criteria for this step is tested separately here and graded only with respect to the vaccine forecast. Date when Vaccine Overdue may be omitted for the Influenza Vaccine. For MMR, the 2nd dose is due 10/31/19 according to the schedule. Since the first one was given too early, the child is behind. Verify that the EHR shows all 3 dates returned by the registry: - Earliest Date to Give - Vaccine Due Date - Date When Vaccine Overdue |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Query the Registry for Juana Mariana Vazquez | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Patient Identifier | ||
| ID Number | 123456 | |
| Assigning Authority | ||
| Namespace ID | MYEHR | |
| ID Type | MR | |
| Patient Identifier | ||
| ID Number | 987633 | |
| Assigning Authority | ||
| Namespace ID | MYIIS | |
| ID Type | SR | |
| Name | Juana Mariana Vazquez | |
| Date of Birth | 11/01/2016 | |
| Sex | Female | |
| Address 1 | ||
| Street | 4345 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | USA | |
| Address Type | L | |
| Mother's Maiden Name | Maria Merida Acosta | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||
| Evaluated Immunization History Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Entering Organization | Shoreline Hospital | |
| Vaccine Group | hepatitis B vaccine, unspecified formulation | |
| Vaccine Administered | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| Refusal Reason | ||
| Date/Time Administration-Start | 11/01/2016 | |
| Date/Time Administration-End | 11/01/2016 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | Jane Carter | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | SH | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Shoreline Pediatrics | |
| Vaccine Group | hepatitis B vaccine, unspecified formulation | |
| Vaccine Administered | hepatitis B vaccine, unspecified formulation | |
| Refusal Reason | ||
| Date/Time Administration-Start | 12/20/2016 | |
| Date/Time Administration-End | 12/20/2016 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | Sandra Molina | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | SP | |
| Street Address | 400 Shoreline Drive | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | hepatitis B vaccine, unspecified formulation | |
| Vaccine Administered | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/20/2017 | |
| Date/Time Administration-End | 05/20/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/22/2017 | |
| Date/Time Administration-End | 05/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| Refusal Reason | ||
| Date/Time Administration-Start | 02/21/2018 | |
| Date/Time Administration-End | 02/21/2018 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 4 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | ||
| Other Designation | ||
| City | ||
| State | ||
| Zip Code | ||
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/22/2017 | |
| Date/Time Administration-End | 05/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| Refusal Reason | ||
| Date/Time Administration-Start | 11/21/2017 | |
| Date/Time Administration-End | 11/21/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 4 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | poliovirus vaccine, inactivated | |
| Vaccine Administered | poliovirus vaccine, inactivated | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Arm | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | poliovirus vaccine, inactivated | |
| Vaccine Administered | poliovirus vaccine, inactivated | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Arm | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | pneumococcal conjugate vaccine, 13 valent | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | pneumococcal conjugate vaccine, 13 valent | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | pneumococcal conjugate vaccine, 13 valent | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/22/2017 | |
| Date/Time Administration-End | 05/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | pneumococcal conjugate vaccine, 13 valent | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/11/2018 | |
| Date/Time Administration-End | 01/11/2018 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 4 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | rotavirus, unspecified formulation | |
| Vaccine Administered | rotavirus, live, monovalent vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 01/22/2017 | |
| Date/Time Administration-End | 01/22/2017 | |
| Administered Amount | 1.0 | |
| Administered Units of Measure | mL | |
| Route of Administration | Oral | |
| Administration Site | ||
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | rotavirus, unspecified formulation | |
| Vaccine Administered | rotavirus, live, monovalent vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/23/2017 | |
| Date/Time Administration-End | 03/23/2017 | |
| Administered Amount | 1.0 | |
| Administered Units of Measure | mL | |
| Route of Administration | Oral | |
| Administration Site | ||
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/25/2017 | |
| Date/Time Administration-End | 09/25/2017 | |
| Administered Amount | 0.25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| Refusal Reason | ||
| Date/Time Administration-Start | 10/29/2017 | |
| Date/Time Administration-End | 10/29/2017 | |
| Administered Amount | 0.25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza, injectable, quadrivalent, preservative free, pediatric | |
| Refusal Reason | ||
| Date/Time Administration-Start | 10/02/2018 | |
| Date/Time Administration-End | 10/02/2018 | |
| Administered Amount | .25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | ||
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | ||
| Number of Doses in Series | ||
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| Refusal Reason | ||
| Date/Time Administration-Start | 11/04/2019 | |
| Date/Time Administration-End | 11/04/2019 | |
| Administered Amount | 0.25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | ||
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | ||
| Number of Doses in Series | ||
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hep A, unspecified formulation | |
| Vaccine Administered | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| Refusal Reason | ||
| Date/Time Administration-Start | 11/23/2017 | |
| Date/Time Administration-End | 11/23/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Deltoid | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | ||
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hep A, unspecified formulation | |
| Vaccine Administered | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/23/2018 | |
| Date/Time Administration-End | 05/23/2018 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | ||
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Shoreline Pediatrics | |
| Vaccine Group | MMR | |
| Vaccine Administered | measles, mumps, rubella virus vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 08/22/2017 | |
| Date/Time Administration-End | 08/22/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | Sandra Molina | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | SP | |
| Street Address | 400 Shoreline Drive | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | NO | |
| Validity Reason | Early | |
| Completion Status* | Complete | |
| Dose Number in Series | ||
| Number of Doses in Series | ||
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | MMR | |
| Vaccine Administered | measles, mumps, rubella virus vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/22/2020 | |
| Date/Time Administration-End | 09/22/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Arm | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Varicella virus vaccine | |
| Vaccine Administered | varicella virus vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 12/15/2018 | |
| Date/Time Administration-End | 12/15/2018 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Right Arm | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | new immunization record | |
| Administering Provider | ||
| Name | J Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 333 Oceanview Lane | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||
| Immunization Forecast | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Vaccine Group | IPV | |
| Vaccine Due Date | 04/29/2017 | |
| Earliest Date to Give | 04/29/2017 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 04/30/2018 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Due Date | 09/01/2021 | |
| Earliest Date to Give | 09/01/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 10/31/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | MMR | |
| Vaccine Due Date | 10/31/2020 | |
| Earliest Date to Give | 10/31/2020 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 10/31/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Varicella | |
| Vaccine Due Date | 10/31/2020 | |
| Earliest Date to Give | 10/31/2020 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 10/31/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Description |
|---|
Juana Mariana Vazquez immunization registry provided Evaluated History and Forecast is reconciled with the Immunization history information in the EHR. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR, and the response is available in the EHR for reconciliation and import. |
| Post-Condition |
|---|
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Vazquez). |
| Test Objectives |
|---|
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.
Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.
Review Patient Immunization History: The EHR or other clinical software systems displays vaccine history by vaccine series.
Support for: Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required. |
| Evaluation Criteria | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The user imports the vaccination, date administered, and documents adverse reactions reconciled from the returned vaccinations as follows: Vaccinations NOT imported:
Vaccinations Imported:
2. The tester verifies that the Reconciled Patient Immunization History can be displayed to the user. |
| Notes |
|---|
No Note |
| Description |
|---|
Once the vaccine history is reconciled in the EHR, the vaccine forecast is updated. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
EHR Vaccine History is Reconciled with Immunization History from the IIS (previous step 'Reconcile and import vaccinations from Evaluated History and Forecast returned by the Registry for Juana Mariana Vazquez'). |
| Post-Condition |
|---|
An updated vaccine forecast based upon the reconciled vaccine history is available to the user. |
| Test Objectives |
|---|
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. |
| Evaluation Criteria | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history: 1. Verify that the EHR does not include in reconciled vaccine forecast:
2. Verify that the EHR includes in reconciled vaccine forecast:
|
| Notes |
|---|
The due date must be in range for the date shown. Vaccine forecast dates may be plus or minus 10 days to accommodate differences in date handling. Since Influenza is seasonal, forecasting of Influenza may vary by test date. Once the Flu season is past, the next Flu vaccine forecast will be for the next season. The forecasting for children who are playing immunization catch-up may differ from the standard immunization forecast. Tester should document incidences where influenza is not forecasted and verify that the rationale for the omission is due to the date of the test. Variations relating to IPV refusals and catch-up should also be documented by the tester. Overdue date may be omitted for influenza. While there is not an expected recommendation for the earliest date to give for influenza, this may appear in some EHR implementations. Tester should note if this is included. Further variation should be documented in the notable exceptions, but minimally each forecast vaccine must be present. |
| Description |
|---|
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juana Mariana Vazquez is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariana Vazquez Initial Data Load.’ |
| Post-Condition |
|---|
Visit orders are entered in Juana Mariana Vazquez's record. |
| Test Objectives |
|---|
Notify of Previous Adverse Event: The EHR or other clinical software system alerts providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record. Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.
Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required. Receive Dose Not Indicated Alert Upon Vaccine Administration: The system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals. Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Receive Dose Not Indicated Alert Upon Vaccine Administration: The system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals. Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.
Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details. Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or prefilled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry. Data Quality Checks: The EHR or other clinical software system integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:
|
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The provider accesses the record for Juana Mariana Vazquez and: - Selects order for IPV and views information about the prior febrile seizure post-IPV vaccine. - IPV is ordered for the patient. |
| Comments |
|---|
In this step, the order is recorded after receiving the alert. This step is followed by parental refusal when the administration is attempted. |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. |
| Post-Condition |
|---|
IPV order entered in patient record. User notified of history of adverse reaction to IPV (febrile seizures). |
| Test Objectives |
|---|
Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.
Notify of Previous Adverse Event: The EHR or other clinical software system alerts providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record. |
| Evaluation Criteria | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR records the following order information and Alert. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:
|
| Notes |
|---|
No Note |
| Description |
|---|
The provider attempts to document vaccine refusal information for the immunization for Juana Mariana Vazquez. These data quality checks primarily relate to improving vaccine refusal information and associated observations that will be included when submitting data to the immunization registry. |
| Comments |
|---|
Evaluates EHR functions for verifying data quality of vaccine refusal data and associated observations used for reporting vaccinations to the immunization registry. There is no transaction associated with this test step. |
| Pre-condition |
|---|
Order is placed for the IPV vaccine. |
| Post-Condition |
|---|
The EHR has alerted the provider for each of the vaccine refusal data quality checks verified for Juana Mariana Vazquez. |
| Test Objectives |
|---|
Data Quality Checks: Integrate additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2008 : Indicates that either a refusal reason was messaged in RXA-18 when the completion status in RXA-20 was not RE or a valid refusal reason was not messaged when the completion status was RE. |
| Evaluation Criteria | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Evaluation Criteria: During the course of data entry for the variant information below, the EHR triggers the following data quality issues:
|
| Notes |
|---|
The full vaccination refusal details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step. |
| Description |
|---|
The mother is concerned about administering the IPV due to the prior adverse reaction and refuses to have the child immunized for IPV. The provider documents mother's refusal for IPV vaccine indicating the parent decision, the reason and documents a deferral at the time of attempted administration. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Prior Immunization History loaded and reconciled from the Immunization Registry. Order is entered for IPV. Provider has been alerted to prior adverse reaction to IPV of febrile seizures. |
| Post-Condition |
|---|
Vaccine non-administration due to parental refusal is documented in the patient record. Deferral is recorded. |
| Test Objectives |
|---|
Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed. |
| Evaluation Criteria | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
The EHR documents the non-administration of the IPV due to the parental refusal. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:
|
| Notes |
|---|
No Note |
| Description |
|---|
The EHR vendor loads immunization history data for an MMR dose entered 2 weeks prior to the current visit date and an MMR dose that was given too early. These MMR doses serve to seed checking for the condition that it is too early to give a live vaccine in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Juana Mariana Vazquez, Enter Orders and Immunizations, TestStep: Attempt to order Varicella Dose. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariana Vazquez. All test steps that are part of the Query the Registry for Juana Mariana test steps are completed, including the vaccination forecasting. |
| Post-Condition |
|---|
The immunization history of the MMR that was administered 2 weeks prior to the test date is loaded into the record created for Juana Mariana Vazquez. |
| Test Objectives |
|---|
Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.
Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.
Supporting data for: Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required. Receive Dose Not Indicated Alert Upon Vaccine Administration: The system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals. |
| Evaluation Criteria | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:
|
| Notes |
|---|
The MMR doses serve to seed checking for the condition that it is too early to give a live vaccine in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Juana Mariana Vazquez, Enter Orders and Immunizations, TestStep: Attempt to order Varicella Dose. |
| Description |
|---|
The provider attempts to give a Varicella dose and is warned that it is too soon to give a live vaccine dose. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial data load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. MMR dose entered at 14 days prior to the current date in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Juana Mariana Vazquez, Enter Immunization Data for MMR Given 2 Weeks Prior. |
| Post-Condition |
|---|
The provider has been issued a warning that it is too soon to give another live virus dose. |
| Test Objectives |
|---|
Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required. |
| Evaluation Criteria |
|---|
There should be a warning that the attempt to give a new Varicella Dose is too early - should get warning that 28 days must pass between 2 live virus vaccines if not administered at the same time due to the prior MMR vaccination 14 days earlier. |
| Notes |
|---|
If the checking that the dose is too early is handled in the forecast logic rather than the orders interface, this is acceptable to demonstrate the capability. It can be expressed where it is not part of the recommended forecast and showing it is not 'due' or recommended until a later date. |
| Description |
|---|
The physician accesses the record for Juana Mariana Vazquez and: - Selects order for Influenza vaccine. |
| Comments |
|---|
This order is a pre-condition to the following two steps related to recording the Influenza vaccine. |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. |
| Post-Condition |
|---|
Influenza order entered in patient record. |
| Test Objectives |
|---|
Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines. |
| Evaluation Criteria | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR records the following order information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:
|
| Notes |
|---|
No Note |
| Description |
|---|
The provider attempts to document vaccine route, site, and administration amount for the influenza immunization for Juana Mariana Vazquez. These data quality checks primarily relate to improving vaccine dosing and administration information that will be included in the vaccination details when submitting data to the immunization registry. The nurse documents administration route for the IM inactivated influenza vaccine as 'intranasal': - Is alerted when documenting "intranasal" for intramuscular inactivated influenza vaccine. - Is alerted when documenting the incorrect administration amount for the vaccine administered. |
| Comments |
|---|
Evaluates EHR functions for verifying data quality of vaccine dosing and administration data used for reporting vaccinations to the immunization registry. There is no transaction associated with this test step. |
| Pre-condition |
|---|
Order is placed for intramuscular inactivated influenza vaccine. |
| Post-Condition |
|---|
The EHR has alerted the provider for each of the vaccine dosing and administration data quality checks verified for Juana Mariana Vazquez. |
| Test Objectives |
|---|
Data Quality Checks: Integrate additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.
Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2014: Indicates that the administration amount is inconsistent with the vaccine administered - 2016 : Indicates that the administration route is inconsistent with the vaccine administered Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The National Drug Code and manufacturer data elements (NDC) is embedded in the Global Trade Item Number (GTIN). Using mapping tables, the manufacturer can be determined from the NDC Code. The NDC and manufacturer data elements are later transmitted to an IIS by cross walking/mapping from the GTIN. The software system records this information as structured data elements. |
| Evaluation Criteria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Evaluation Criteria: During the course of data entry for the variant information below, the EHR triggers the following data quality issues:
The EHR Records the following vaccine administration information:
|
| Notes |
|---|
The full vaccination details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step. While this test step requires verification of an appropriate route, the SUT should be sure that alternate route documentation is not restricted. While not part of this use case, there are situations where an alternate site may be medically indicated. |
| Description |
|---|
The nurse administers the inactivated influenza vaccine: - Documents all required information for the vaccine. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Order is placed for inactivated influenza vaccine. |
| Post-Condition |
|---|
The inactivated influenza vaccinations is recorded in the EHR. |
| Test Objectives |
|---|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assures dose is appropriate for the vaccine). Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The National Drug Code and manufacturer data elements (NDC) is embedded in the Global Trade Item Number (GTIN). Using mapping tables, the manufacturer can be determined from the NDC Code. The NDC and manufacturer data elements are later transmitted to an IIS by cross walking/mapping from the GTIN. The software system records this information as structured data elements. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The tester Verifies that there is a choice for VFC stock as she is VFC Eligible. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions: The EHR records the following vaccine administration information, and using the 2D Bar code found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:
|
| Notes |
|---|
The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical). |
| Description |
|---|
Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EHR imported from the IIS. |
| Comments |
|---|
The report must include all newly administered vaccines in any order. The report should also include the corrected information where the EHR has different information than the IIS and may also include the information imported from the IIS. |
| Pre-condition |
|---|
The vaccines for the visit have been administered. |
| Post-Condition |
|---|
The IIS has received the vaccine information (Z22 message). |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
Sending information updated in the EHR back to the registry is an advanced function and some registries will not accept updates. |
| Description |
|---|
Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EHR imported from the IIS. |
| Comments |
|---|
The report must include all newly administered vaccines in any order. The report should also include the corrected information where the EHR has different information than the IIS and may also include the information imported from the IIS. |
| Pre-condition |
|---|
The vaccines for the visit have been administered. |
| Post-Condition |
|---|
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
| Notes |
|---|
Sending information updated in the EHR back to the registry is an advanced function and some registries will not accept updates. The test data anticipates that the entire vaccine history is included in the message transmitted to the registry. Due to variation in practice, it is acceptable for the message to include only new vaccinations or only new vaccinations with updated content. The tester should document such instances, and may augment the submitted test message with such missing ‘history’ in order to run the test without error. All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘). |
| Element | Data |
|---|---|
| Patient Name | Juana Mariana Vazquez |
| Mother's Maiden Name | Maria Acosta |
| ID Number | 123456 987633 |
| Date/Time of Birth | 11/01/2016 11:05 |
| Administrative Sex | Female |
| Patient Address | 4345 Standish Way Stamford CT 06903 USA |
| Local Number | (203)555-1212 |
| jmg@gmail.com | |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 11/01/2016 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 11/01/2016 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 11/01/2016 |
| Element | Data |
|---|---|
| Name | Joanna Merida Vazquez |
| Relationship | Grandparent |
| Address | 4345 Standish Way Stamford CT 06903 |
| Phone Number | (203)555-1212 |
| Phone Number |
| Element | Data |
|---|---|
| Administered Vaccine | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 11/01/2016 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Jane Carter |
| Substance Lot Number | 6332FK33 |
| Substance Expiration Date | 12/14/2016 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Vaccine | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 12/20/2016 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - source unspecified |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6352FK1 |
| Substance Expiration Date | 12/31/2016 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Vaccine | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 05/20/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6352FK24 |
| Substance Expiration Date | 08/31/2018 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified |
| Date/Time Start of Administration | 01/22/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2341 |
| Substance Expiration Date | 11/30/2017 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 03/23/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2433 |
| Substance Expiration Date | 09/04/2017 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 05/22/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS3255 |
| Substance Expiration Date | 12/01/2017 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 02/21/2018 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS249 |
| Substance Expiration Date | 03/01/2018 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 11/20/2020 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D643QS8243 |
| Substance Expiration Date | 12/01/2020 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 01/22/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M54K9245 |
| Substance Expiration Date | 03/24/2017 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 03/23/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M55K3342 |
| Substance Expiration Date | 10/30/2017 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 05/22/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M75K4566 |
| Substance Expiration Date | 05/23/2017 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 11/21/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M53K5534 |
| Substance Expiration Date | 02/22/2018 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 01/22/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV2431 |
| Substance Expiration Date | 10/04/2017 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Arm |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 03/23/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV4344 |
| Substance Expiration Date | 03/23/2018 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Arm |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 02/21/2018 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D335PV9644 |
| Substance Expiration Date | 04/22/2018 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Arm |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | Refused |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Vaccine | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 01/22/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P243V3281 |
| Substance Expiration Date | 01/30/2017 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 03/23/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P343V8321 |
| Substance Expiration Date | 03/30/2017 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 05/22/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V2164 |
| Substance Expiration Date | 08/30/2017 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 01/11/2018 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V58532 |
| Substance Expiration Date | 04/18/2018 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 01/22/2017 |
| Administered Amount | 1.0 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV533 |
| Substance Expiration Date | 02/15/2017 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Oral |
| Administration Site | |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 03/23/2017 |
| Administered Amount | 1.0 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV932 |
| Substance Expiration Date | 05/10/2017 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Oral |
| Administration Site | |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 09/25/2017 |
| Administered Amount | 0.25 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 07/25/2018 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/29/2017 |
| Administered Amount | 0.25 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8746 |
| Substance Expiration Date | 03/12/2018 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | Influenza, injectable, quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/02/2018 |
| Administered Amount | .25 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9334IN9333 |
| Substance Expiration Date | 05/22/2019 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 11/04/2019 |
| Administered Amount | 0.25 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9553IN2243 |
| Substance Expiration Date | 04/30/2020 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | Influenza, injectable, quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/15/2020 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from parent's written record |
| Administering Provider | Gina Ricci |
| Substance Lot Number | 8L4B3423 |
| Substance Expiration Date | 12/30/2020 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Gina Ricci |
| Element | Data |
|---|---|
| Administered Vaccine | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 8L4B3521 |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Document Type | Influenza Vaccine - Inactivated VIS |
| VIS Presentation Date | 10/31/2021 |
| vaccine fund pgm elig cat | VFC eligible-Medicaid/Medicaid Managed Care |
| Vaccine funding source | Public |
| Element | Data |
|---|---|
| Administered Vaccine | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 11/23/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT33 |
| Substance Expiration Date | 01/04/2018 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 05/23/2018 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT48 |
| Substance Expiration Date | 09/11/2018 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | measles, mumps, rubella virus vaccine |
| Date/Time Start of Administration | 08/22/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - source unspecified |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 0853CC |
| Substance Expiration Date | 12/15/2017 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Vaccine | measles, mumps, rubella virus vaccine |
| Date/Time Start of Administration | 09/22/2020 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 0854FF |
| Substance Expiration Date | 04/13/2021 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Arm |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Vaccine | measles, mumps, rubella virus vaccine |
| Date/Time Start of Administration | 10/15/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from parent's written record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 0934GG |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Arm |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Vaccine | varicella virus vaccine |
| Date/Time Start of Administration | 12/15/2018 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 2341BB |
| Substance Expiration Date | 12/01/2019 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Right Arm |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Description |
|---|
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A VXU message is generated by the EHR. |
| Post-Condition |
|---|
The ACK Z23 is received by the EHR. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. |
| Evaluation Criteria |
|---|
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. This is not typically part of the user interface, so this may be demonstrated through back-end evidence. |
| Notes |
|---|
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
Following the vaccine administration, the mother reports that the patient had a rash within 14 days of dose. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
The vaccinations for the visit have been administered. |
| Post-Condition |
|---|
The adverse reaction to the Influenza vaccination of rash within 14 days of dose is recorded in the EHR. |
| Test Objectives |
|---|
Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events. |
| Evaluation Criteria |
|---|
Verify that vendor can record the adverse reaction to the Influenza vaccination of rash within 14 days of dose correctly and without omission (VXC14). The coded value is not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions. If the vendor is unable to record the concept (VXC14) using the CDCPHINVS coding system, the vendor may specify the reaction using SNOMED-CT or Narrative Text. This should be recorded as passing, but with a notable exception documented. |
| Notes |
|---|
Adverse Reactions may be documented with SNOMED-CT or as a narrative note. These two approaches may be considered passing with notable exception. The approach that is used instead of the value set PHVS_VaccinationReaction_IIS 2.16.840.1.114222.4.11.3289 should be documented in the tester notes. The test data anticipates that the entire vaccine history is included in the message transmitted to the registry. Due to variation in practice, it is acceptable for the message to include only the record with the adverse reaction. The tester should document such instances and may augment the submitted test message with such missing ‘history’ in order to run the test without error. |
| Description |
|---|
Following the vaccination visit, the provider uses the EHR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.). |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered. |
| Post-Condition |
|---|
The patient/parent has been provided a patient immunization history report. |
| Test Objectives |
|---|
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.
Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
Following the vaccination visit, the provider uses the EHR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.). |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered. |
| Post-Condition |
|---|
The patient/parent has been provided a patient immunization history report. |
| Test Objectives |
|---|
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.
Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame. |
| Evaluation Criteria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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The following patient demographics are displayed:
The following Vaccination History is displayed:
|
| Notes |
|---|
The immunization report may provide a subset of demographic information sufficient to identify the patient. Any demographic information included should be evaluated against the listed demographic information for accuracy. The immunization report does not need to display all of the information listed in the evaluation criteria for each vaccination, but they do need to produce the complete list of vaccines given and the date. The tester is requested to document separately the success or failure of the Immunization History and the Immunization forecast as these two requirements are tested concurrently. Influenza vaccine should be due between September and October of the flue season, which may show as the prior year to testing or the year of testing. |
| Description |
|---|
Following the vaccination visit, the provider uses the EHR to produce an immunization report that can be accessed by the patient including all history and forecast information. The report can be provided in various formats, including view, and print. The patient is also able to access the Vaccine Information Statements. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered. |
| Post-Condition |
|---|
The patient/parent has been provided access to ta patient immunization history record. |
| Test Objectives |
|---|
Provide Access to Patient Immunization Record: The EHR or other clinical software system provides patients and their authorized representatives with electronic access to immunization records (either directly or by interacting with an external system such as a patient portal). Provide Access to Recommendations and Vaccine Information Statement(s): The immunization record displays immunization recommendations to be discussed with a provider, displaying the relevant Vaccine Information Statement. Provide Access to Printable Immunization Record: The EHR or other clinical software system provides a printable version of the immunization record. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
Following the vaccination visit, the patient/parent uses the specified interface to access the immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.). |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered. The parent/patient is provided with an account to access the immunization history. |
| Post-Condition |
|---|
The patient/parent has been provided a patient immunization history report. |
| Test Objectives |
|---|
Provide Access to Patient Immunization Record: The EHR or other clinical software system provides patients and their authorized representatives with electronic access to immunization records (either directly or by interacting with an external system such as a patient portal). Provide Access to Recommendations and Vaccine Information Statement(s): The immunization record displays immunization recommendations to be discussed with a provider, displaying the relevant Vaccine Information Statement. |
| Evaluation Criteria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Using the patient facing features (e.g. portal), show that the vaccine history can be displayed including today's vaccine/forecast: The following patient demographics are displayed:
The following Vaccination History is displayed:
|
| Notes |
|---|
If the same immunization report verified in TestCase 4 for Juana Mariana Vazquez is used for the patient access to the immunization record, then content verification does not need to be repeated. Influenza vaccine should be due between September and October of the flu season, which may show as the prior year to testing or the year of testing. Also, since MMR was given 2 weeks prior, forecasting of immunizations due may be adjusted by the vendor forecast to account for the requirement there must be at least 28 days between immunizations using a live virus. Tester should document incidences where the forecast is adjusted or annotated as a result of this requirement. |
| Description |
|---|
Following the vaccination visit, the patient/parent uses the specified interface to print the immunization report for the patient including all history and forecast information. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered. The parent/patient is provided with an account to access the immunization history. |
| Post-Condition |
|---|
The patient/parent has been provided a printed copy of the patient immunization history report. |
| Test Objectives |
|---|
Provide Access to Patient Immunization Record: The EHR or other clinical software system provides patients and their authorized representatives with electronic access to immunization records (either directly or by interacting with an external system such as a patient portal). Provide Access to Printable Immunization Record: The EHR or other clinical software system provides a printable version of the immunization record. |
| Evaluation Criteria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Using the patient facing features (e.g. portal), show that the vaccine history including today's vaccine/forecast can be printed: The following patient demographics are included in the printable report:
The following Vaccination History is displayed:
|
| Notes |
|---|
If the same immunization report verified in TestCase 4 for Juana Mariana Vazquez is used for the patient access to the immunization record, then content verification does not need to be repeated. Influenza vaccine should be due between September and October of the flu season, which may show as the prior year to testing or the year of testing. Also, since MMR was given 2 weeks prior, forecasting of immunizations due may be adjusted by the vendor forecast to account for the requirement there must be at least 28 days between immunizations using a live virus. Tester should document incidences where the forecast is adjusted or annotated as a result of this requirement. |
| Description |
|---|
The EHR is used to provide the patient access to the Vaccine Information Statements (VIS) for those vaccines administered during the visit. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered. The parent/patient is provided with an account to access the Vaccine Information Statements (VIS). |
| Post-Condition |
|---|
The patient/parent has been provided access to the Vaccine Information Statements (VIS) for those vaccines administered during the visit. |
| Test Objectives |
|---|
Provide Access to Recommendations and Vaccine Information Statement(s): The immunization record displays immunization recommendations to be discussed with a provider, displaying the relevant Vaccine Information Statement. |
| Evaluation Criteria | ||||||||
|---|---|---|---|---|---|---|---|---|
Using the patient facing features (e.g. portal), show that the patient can access the Vaccine Information Statements (VIS) for those vaccines administered during today's visit:
|
| Notes |
|---|
The VIS may be provided as a link, PDF, or other format, but the VIS must be the current VIS for the product administered during the visit. The EHR does not need to provide access to VIS from historical vaccinations. |
| Description |
|---|
| Comments |
|---|
| Pre-condition |
|---|
| Post-Condition |
|---|
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Notes |
|---|
| Description |
|---|
Querying the registry will consist of the vendor creating Z44 messages for Juan Marcel Marina to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity. Using the Z42 Response to Immunization Registry Query, the EHR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry and create a new forecast after reconciling the information. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juan Marcel Marina is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juan Marcel Marina Initial Data Load'. |
| Post-Condition |
|---|
A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned. |
| Test Objectives |
|---|
Select New Patient: The EHR or other clinical system system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software system. This information is crucial for identifying and selecting the correct patient. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.
Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).
Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. Review Patient Immunization History: The EHR or other clinical software system displays vaccine history by vaccine series.
Support for: Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
Juan Marcel Marina is selected as the patient and his record is opened in the EHR. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juan Marcel Marina Initial Data Load completed. |
| Post-Condition |
|---|
Juan Marcel Marina is the active working patient in the EHR. |
| Test Objectives |
|---|
Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software system. This information is crucial for identifying and selecting the correct patient. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Tester shall verify that the product can distinguish Juan Marcel Marina from similar sounding names using all of the pediatric demographics:
|
| Notes |
|---|
No Note |
| Description |
|---|
The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juan Marcel Marina Initial Data Load is completed. Juan Marcel Marina is the active working patient in the EHR. |
| Post-Condition |
|---|
The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juan Marcel Marina. |
| Test Objectives |
|---|
Request/Receipt of Patient Immunization History: The EHR or other clinical system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). |
| Evaluation Criteria |
|---|
Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission. Tester shall verify that the data in the message corresponds to the data in the EHR and contains all test data attributes supplied. |
| Notes |
|---|
No Note |
| Element | Data |
|---|---|
| Patient Name | Juan Marcel Marina |
| Mother's Maiden Name | Morales |
| ID Number | 123456 |
| Date/Time of Birth | 03/04/2020 11:00 |
| Sex | Male |
| Patient Address | 4623 Standish Way Stamford CT 06903 USA |
| Patient Phone | (203)555-1213 |
| Birth Indicator | No |
| Birth Order |
| Description |
|---|
The physician accesses the record for Juan Marcel Marina and: - Accepts the vaccines provided by the registry as this is a new patient and there are no prior vaccines recorded. |
| Comments |
|---|
There is no reconciliation step as there are no historical immunizations in the EHR. All will be imported from the Z42 response. |
| Pre-condition |
|---|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import. |
| Post-Condition |
|---|
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juan Marcel Marina). |
| Test Objectives |
|---|
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.
Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.
Review Patient Immunization History: The EHR or other clinical software system displays vaccine history by vaccine series. Supporting data for: Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required. |
| Evaluation Criteria | ||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. The EHR displays the information returned from the Immunization Registry according to the Juror Document. 2. The user imports returned vaccinations as follows using only the vaccination, and administration dates returned from the Immunization Registry: a. Vaccinations Imported:
|
| Notes |
|---|
The EHR must minimally display the vaccine administered and the date of the immunization. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Query the Registry for Juan Marcel Marina | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Patient Identifier | ||
| ID Number | 123456 | |
| Assigning Authority | ||
| Namespace ID | MYEHR | |
| ID Type | MR | |
| Patient Identifier | ||
| ID Number | 987633 | |
| Assigning Authority | ||
| Namespace ID | MYIIS | |
| ID Type | SR | |
| Name | Juan Marcel Marina | |
| Date of Birth | 03/04/2020 | |
| Sex | Male | |
| Address 1 | ||
| Street | 4623 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | USA | |
| Address Type | L | |
| Mother's Maiden Name | Anita Francesca Morales | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||
| Evaluated Immunization History Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Entering Organization | Shoreline Hospital | |
| Vaccine Group | hepatitis B vaccine, unspecified formulation | |
| Vaccine Administered | Hepatitis B | |
| Refusal Reason | ||
| Date/Time Administration-Start | 03/04/2020 | |
| Date/Time Administration-End | 03/04/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | SH | |
| Street Address | 325 Shoreline Drive | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | hepatitis B vaccine, unspecified formulation | |
| Vaccine Administered | Hepatitis B | |
| Refusal Reason | ||
| Date/Time Administration-Start | 04/15/2020 | |
| Date/Time Administration-End | 04/15/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | DTaP | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/15/2020 | |
| Date/Time Administration-End | 05/15/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | DTaP | |
| Refusal Reason | ||
| Date/Time Administration-Start | 07/13/2020 | |
| Date/Time Administration-End | 07/13/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | DTaP | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/16/2020 | |
| Date/Time Administration-End | 09/16/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| Vaccine Administered | DTaP | |
| Refusal Reason | ||
| Date/Time Administration-Start | 08/20/2021 | |
| Date/Time Administration-End | 08/20/2021 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 4 | |
| Number of Doses in Series | 5 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Hib | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/14/2020 | |
| Date/Time Administration-End | 05/14/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Hib | |
| Refusal Reason | ||
| Date/Time Administration-Start | 07/21/2020 | |
| Date/Time Administration-End | 07/21/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Hib | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/27/2020 | |
| Date/Time Administration-End | 09/27/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | Hib, unspecified formulation | |
| Vaccine Administered | Hib | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/04/2021 | |
| Date/Time Administration-End | 05/04/2021 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 4 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | poliovirus vaccine, inactivated | |
| Vaccine Administered | Polio (IPV) | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/14/2020 | |
| Date/Time Administration-End | 05/14/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Arm | |
| Substance Manufacturer Name | MSanofi Pasteur Inc. | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | poliovirus vaccine, inactivated | |
| Vaccine Administered | Polio (IPV) | |
| Refusal Reason | ||
| Date/Time Administration-Start | 07/21/2020 | |
| Date/Time Administration-End | 07/21/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Arm | |
| Substance Manufacturer Name | MSanofi Pasteur Inc. | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | Polio (IPV) | |
| Refusal Reason | ||
| Date/Time Administration-Start | 10/15/2020 | |
| Date/Time Administration-End | 10/15/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Arm | |
| Substance Manufacturer Name | MSanofi Pasteur Inc. | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | Pneumococcal conjugate (PCV13) | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/18/2020 | |
| Date/Time Administration-End | 05/18/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | Pneumococcal conjugate (PCV13) | |
| Refusal Reason | ||
| Date/Time Administration-Start | 07/21/2020 | |
| Date/Time Administration-End | 07/21/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | Pneumococcal conjugate (PCV13) | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/27/2020 | |
| Date/Time Administration-End | 09/27/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 3 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | pneumococcal, unspecified formulation | |
| Vaccine Administered | Pneumococcal conjugate (PCV13) | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/04/2021 | |
| Date/Time Administration-End | 05/04/2021 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Pfizer, Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 4 | |
| Number of Doses in Series | 4 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | rotavirus, unspecified formulation | |
| Vaccine Administered | Rotavirus | |
| Refusal Reason | ||
| Date/Time Administration-Start | 05/18/2020 | |
| Date/Time Administration-End | 05/18/2020 | |
| Administered Amount | 1.0 | |
| Administered Units of Measure | mL | |
| Route of Administration | Oral | |
| Administration Site | ||
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | rotavirus, unspecified formulation | |
| Vaccine Administered | Rotavirus | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/21/2020 | |
| Date/Time Administration-End | 09/21/2020 | |
| Administered Amount | 1.0 | |
| Administered Units of Measure | mL | |
| Route of Administration | Oral | |
| Administration Site | ||
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/27/2020 | |
| Date/Time Administration-End | 09/27/2020 | |
| Administered Amount | 0.25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Administered | Influenza | |
| Refusal Reason | ||
| Date/Time Administration-Start | 10/20/2020 | |
| Date/Time Administration-End | 10/20/2020 | |
| Administered Amount | 0.25 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Right Thigh | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 2 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Oceanview Pediatrics | |
| Vaccine Group | MMR | |
| Vaccine Administered | measles, mumps, rubella virus vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 06/20/2021 | |
| Date/Time Administration-End | 06/20/2021 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Subcutaneous | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | J. Martinez | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | OP | |
| Street Address | 4253 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 2 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||
| Immunization Forecast | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Vaccine Group | Hep B, unspecified formulation | |
| Vaccine Due Date | 09/04/2021 | |
| Earliest Date to Give | 09/04/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 10/04/2021 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Due Date | 09/04/2021 | |
| Earliest Date to Give | 03/04/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | ||
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Varicella | |
| Vaccine Due Date | 03/04/2021 | |
| Earliest Date to Give | 03/04/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | ||
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Hep A, pediatric, unspecified formulation | |
| Vaccine Due Date | 03/04/2021 | |
| Earliest Date to Give | 03/04/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | ||
| Status in Immunization Series | ||
| Forecast Reason | ||
| Description |
|---|
The physician accesses the record for Juan Marcel Marina and, once the vaccine history is reconciled in the EHR, the vaccine forecast is updated. - The provider views the updated vaccine forecast (either as provided by the Immunization Registry or as determined through EHR defined methods). |
| Comments |
|---|
The vaccine forecast may be imported from the Immunization Registry Vaccination History and Forecast (Z42) response, or it may be generated by EHR defined means. |
| Pre-condition |
|---|
EHR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juan Marcel Gonzales). |
| Post-Condition |
|---|
A vaccine forecast based upon the imported vaccine history is available to the user. |
| Test Objectives |
|---|
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses. |
| Evaluation Criteria | ||||
|---|---|---|---|---|
1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history: 2. Verify that the EHR includes in the vaccine forecast:
In support of test objective 'Modify Antigen Recommendations Based on Active Diagnoses' the tester verifies that the system notifies the provider that:
|
| Notes |
|---|
The due date must be in range for the date shown. Vaccine forecast dates may be plus or minus 10 days to accommodate differences in date handling. Further variation should be documented in the notable exceptions, but minimally each forecast vaccine must be present. While there is not an expected recommendation for the earliest date to give for influenza, this may appear in some EHR implementations. Tester should note if this is included. Tester should document how evidence of prior disease (Varicella) is documented (e.g. if not in forecast, is there a reason available to clinician). Manual override does not fulfill the 'modify antigen recommendations based on active diagnoses' (e.g. if the system does not support this through CDS then not fulfilled). This criteria is considered 'Advanced', so tester should note support for this criteria separately. |
| Description |
|---|
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juan Marcel Marina is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juan Marcel Marina Initial Data Load.' |
| Post-Condition |
|---|
Visit orders are entered in Juan Marcel Marina's record. |
| Test Objectives |
|---|
Modify Antigen Recommendations Based on Active Diagnoses: The EHR or other clinical software system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.
Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.
Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required. Receive Dose Not Indicated Alert Upon Vaccine Administration: The EHR or other clinical software system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals.
Notify of Vaccine Dose Expiration: The EHR or other clinical software system notifies the provider administering a vaccine if the dose chosen for administration is expired.
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.
Notify of Vaccine Dose Ineligibility: The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected. Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure publicly funded dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging jurisdiction-specific dose level eligibility code(s) for administered vaccines. This capability only applies to newly administered doses, not historical doses. Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2013: Indicates that the funding source code in an OBX segment conflicts with other data in the message (eligibility, age etc). - 2016: Indicates that the administration route is inconsistent with the vaccine administered - 2001: Indicates a conflict between the administration date in RXA-3 and the expiration date in RXA-16. In other words it indicates that an expired vaccine was administered. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
As indicated by the vaccine forecast, the third Hepatitis B is overdue, and is ordered. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. Vaccine forecast reviewed. |
| Post-Condition |
|---|
Hepatitis B vaccine is ordered for the patient. |
| Test Objectives |
|---|
Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines. |
| Evaluation Criteria | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR records the following order information: The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:
|
| Notes |
|---|
No Note |
| Description |
|---|
The fifth DTaP is ordered, and the provider is notified that the dose is too early. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. Vaccine forecast is available in the EHR. |
| Post-Condition |
|---|
DTaP vaccine is ordered for the patient, and provider is notified that the dose is too early. |
| Test Objectives |
|---|
Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.
Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines. |
| Evaluation Criteria | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR records the following order information and Alert. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:
|
| Notes |
|---|
In step 8 of this TestCase, there will be a request to attempt to record this DTaP dose, which is also expected to result in an alert notification. There may be systems that require an alert override to establish this DTaP order to be able to execute Step 8: Attempt to administer DTaP vaccine and alerted that the dose is too early. |
| Description |
|---|
The nurse documents administration route for the HepB vaccine: - Is prevented from documenting "oral" for HepB vaccine. |
| Comments |
|---|
This step covers data quality checking as an informative aspect of vaccine administration. |
| Pre-condition |
|---|
Order is placed for HepB vaccine. |
| Post-Condition |
|---|
The HepB vaccination route has failed to be recorded as 'oral' in the EHR. |
| Test Objectives |
|---|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2016 : Indicates that the administration route is inconsistent with the vaccine administered |
| Evaluation Criteria |
|---|
The EHR warns the user that 'Oral' as a route for the HepB vaccine is not correct. |
| Notes |
|---|
Verification checking for invalid route or site should not prevent the user from selecting the alternate route or site. While this test case example is not one that would make sense to ignore the warning, there are situations where an alternate site or route may be medically indicated. This test should not be interpreted to restrict the ability of the EHR to document such alternate routes or sites that may be intentionally selected by the clinician. |
| Description |
|---|
The nurse documents administration lot number for the Hepatitis B vaccine: - Is prevented from ordering the Hepatitis B lot as it has expired. - Documents administration from a different lot that is not expired. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Order is placed for Hepatitis B vaccine. |
| Post-Condition |
|---|
The provider has been notified of the expired Hepatitis B vaccination lot. Documentation of a lot to be administered that is not expired is recorded in the EHR. |
| Test Objectives |
|---|
Notify of Vaccine Dose Expiration: The EHR or other clinical software system notifies the provider administering a vaccine if the dose chosen for administration is expired. Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS. Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2001: Indicates a conflict between the administration date in RXA-3 and the expiration date in RXA-16. In other words, it indicates that an expired vaccine was administered. |
| Evaluation Criteria | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
During the course of data entry for the variant information below, the EHR triggers the following data quality issues:
The EHR records the following order information and Alert. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions: The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:
|
| Notes |
|---|
The full vaccination details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step. If the EHR or other clinical system is not supporting the Jurisdiction-specific eligibility code, then mark VFC Eligibility as non-VFC Eligible. |
| Description |
|---|
The nurse administers the Hepatitis B vaccine: - Documents all required information for the vaccine. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Order is placed for Hepatitis B vaccine. |
| Post-Condition |
|---|
The Hepatitis B vaccination is recorded in the EHR. |
| Test Objectives |
|---|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.
Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions. The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:
|
| Notes |
|---|
The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical). If the EHR or other clinical system is not supporting the Jurisdiction-specific eligibility code, then mark Vaccine Program Eligibility as non-VFC Eligible using Private funding source. |
| Description |
|---|
The nurse documents administration for the inactivated influenza vaccine from a VFC source: - Is alerted that the patient is not eligible for VFC. - Orders a different non-VFC lot of inactivated influenza vaccine. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Order is placed for inactivated influenza vaccine. |
| Post-Condition |
|---|
The user is notified of vaccine dose ineligibility. |
| Test Objectives |
|---|
Notify of Vaccine Dose Ineligibility: The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected. Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS. Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2013: Indicates that the funding source code in an OBX segment conflicts with other data in the message (eligibility, age etc). |
| Evaluation Criteria | ||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The provider documents a VFC lot to be administered in the EHR. Once notified that the patient is not eligible for the VFC, then a non-VFC lot is selected. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions: The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:
The Provider selects a non-VFC Lot:
|
| Notes |
|---|
The full vaccination details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step. Administration for the non-VFC dose of this vaccine is completed in the next step. |
| Description |
|---|
The nurse administers the inactivated influenza vaccine: - Documents all required information for each vaccine. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Order is placed for inactivated influenza vaccine. |
| Post-Condition |
|---|
The inactivated influenza vaccine administration is recorded in the EHR. |
| Test Objectives |
|---|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions. The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:
|
| Notes |
|---|
The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical). |
| Description |
|---|
The provider attempts to administer the fifth DTaP vaccine, and the provider is notified that the dose is too early. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Order is placed for DTaP vaccine. |
| Post-Condition |
|---|
DTaP vaccine is not administered to the patient, following notification that the dose is too early. |
| Test Objectives |
|---|
Receive Dose Not Indicated Alert Upon Vaccine Administration: The EHR or other clinical software system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals. |
| Evaluation Criteria | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The provider prepares to administer the 5th DTaP vaccine, and system alerts the provider that the dose is too early. The provider records the following order information with an indication of a similar Alert.:
|
| Notes |
|---|
The EHR may not allow for recording of a vaccine administration if the DTaP has not been ordered. This may require an override or alert acceptance in Step 2: Orders administration of DTaP vaccine and alerted that the dose is too early. 2D Barcode is not included as this test case does not result in a vaccine administration. |
| Description |
|---|
Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EHR imported from the IIS. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
The vaccines for the visit have been administered. |
| Post-Condition |
|---|
The IIS has received the vaccine information (Z22 message). |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines, and an indication that Varicella was not administered due to a history of the disease as evidence of immunity. The Vaccination report also includes an indication that Hepatitis A was not administered due to serological evidence of immunity. The report MAY send the immunizations that the EHR imported from the IIS. |
| Comments |
|---|
The Report must include all newly administered vaccines in any order. The report may include the information imported from the IIS. |
| Pre-condition |
|---|
The vaccines for the visit have been administered. The clinical information has been documented for Juan Marcel Marina in the Initial Data Load. |
| Post-Condition |
|---|
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses. |
| Evaluation Criteria |
|---|
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. This includes indication that Varicella was not administered due to history of the disease, and an indication that Hepatitis A was not administered due to serological evidence of immunity. |
| Notes |
|---|
All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘). If the EHR or other clinical system is not supporting the Jurisdiction-specific eligibility code, then OBX observation for VFC-Eligibility may pass with notable exception using vaccine program eligibility as non-VFC Eligible and OBX observation for funding source using Private funding source. The message may fail to validate because the new Vaccine Program Eligibility code is not in the HL70064_IZ code set. This is expected behavior and the system may pass with notable exception. |
| Element | Data |
|---|---|
| Patient Name | Juan Marcel Marina |
| Mother's Maiden Name | Anita Morales |
| ID Number | 123456 987633 |
| Date/Time of Birth | 03/04/2020 11:00 |
| Administrative Sex | Male |
| Patient Address | 4623 Standish Way Stamford CT 06903 USA |
| Local Number | (203)555-1213 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 03/04/2020 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 03/04/2020 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 03/04/2020 |
| Element | Data |
|---|---|
| Name | Manuel Marcel Marina |
| Relationship | Father |
| Address | 4623 Standish Way Stamford CT 06903 |
| Phone Number | (203)555-1213 |
| Element | Data |
|---|---|
| Administered Vaccine | Hepatitis B |
| Date/Time Start of Administration | 03/04/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6332FK34 |
| Substance Expiration Date | 12/14/2020 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Vaccine | Hepatitis B |
| Date/Time Start of Administration | 04/15/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6352FK2 |
| Substance Expiration Date | 10/01/2020 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Hepatitis B |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6332FK26 |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Date vaccine information statement presented | 10/31/2021 |
| Document Type | Hepatitis B Vaccine VIS |
| vaccine fund pgm elig cat | HEPB09- Privately Insured |
| Vaccine funding source | Public non-VFC |
| Element | Data |
|---|---|
| Administered Vaccine | DTaP |
| Date/Time Start of Administration | 05/15/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D409QS2342 |
| Substance Expiration Date | 11/30/2021 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | DTaP |
| Date/Time Start of Administration | 07/13/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D409QS2434 |
| Substance Expiration Date | 09/04/2020 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | DTaP |
| Date/Time Start of Administration | 09/16/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D409QS3256 |
| Substance Expiration Date | 12/01/2020 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | DTaP |
| Date/Time Start of Administration | 08/20/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D409QS250 |
| Substance Expiration Date | 03/01/2022 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Hib |
| Date/Time Start of Administration | 05/14/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7M54K9255 |
| Substance Expiration Date | 03/24/2021 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Hib |
| Date/Time Start of Administration | 07/21/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7M55K3343 |
| Substance Expiration Date | 10/30/2020 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Hib |
| Date/Time Start of Administration | 09/27/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7M75K4577 |
| Substance Expiration Date | 05/23/2021 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Hib |
| Date/Time Start of Administration | 05/04/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7M53K5535 |
| Substance Expiration Date | 10/14/2021 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Polio (IPV) |
| Date/Time Start of Administration | 05/14/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D333PV2444 |
| Substance Expiration Date | 10/04/2021 |
| Substance Manufacturer Name | MSanofi Pasteur Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Arm |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Polio (IPV) |
| Date/Time Start of Administration | 07/21/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D333PV4343 |
| Substance Expiration Date | 03/23/2021 |
| Substance Manufacturer Name | MSanofi Pasteur Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Arm |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Polio (IPV) |
| Date/Time Start of Administration | 10/15/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D333PV9654 |
| Substance Expiration Date | 02/22/2021 |
| Substance Manufacturer Name | MSanofi Pasteur Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Arm |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Pneumococcal conjugate (PCV13) |
| Date/Time Start of Administration | 05/18/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | P243V3321 |
| Substance Expiration Date | 01/30/2021 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Pneumococcal conjugate (PCV13) |
| Date/Time Start of Administration | 07/21/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | P343V8445 |
| Substance Expiration Date | 03/30/2021 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Pneumococcal conjugate (PCV13) |
| Date/Time Start of Administration | 09/27/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | P853V2175 |
| Substance Expiration Date | 08/30/2021 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Pneumococcal conjugate (PCV13) |
| Date/Time Start of Administration | 05/04/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | P853V58544 |
| Substance Expiration Date | 10/18/2021 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Rotavirus |
| Date/Time Start of Administration | 05/18/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6359RV543 |
| Substance Expiration Date | 10/29/2020 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Oral |
| Administration Site | |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Rotavirus |
| Date/Time Start of Administration | 09/21/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 6359RV933 |
| Substance Expiration Date | 05/10/2021 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Oral |
| Administration Site | |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Influenza |
| Date/Time Start of Administration | 09/27/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D8043IN8738 |
| Substance Expiration Date | 03/12/2021 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Influenza |
| Date/Time Start of Administration | 10/20/2020 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | D8043IN8798 |
| Substance Expiration Date | 05/22/2021 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | Influenza |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 0.25 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Sandra Molina |
| Substance Lot Number | D8043IN8855 |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Document Type | Influenza Vaccine - Inactivated VIS |
| VIS Presentation Date | 10/01/2021 |
| vaccine fund pgm elig cat | Not VFC elig |
| Vaccine funding source | Private |
| Element | Data |
|---|---|
| Administered Vaccine | measles, mumps, rubella virus vaccine |
| Date/Time Start of Administration | 06/20/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | J. Martinez |
| Substance Lot Number | 7W27V7632 |
| Substance Expiration Date | 12/15/2022 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J. Martinez |
| Ordered By | J. Rodriguez |
| Element | Data |
|---|---|
| Administered Vaccine | No vaccine administered |
| Date/Time Start of Administration | 03/16/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Not Administered |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| vaccine type | varicella |
| Disease with presumed immunity | History of Varicella infection |
| Element | Data |
|---|---|
| Administered Vaccine | No vaccine administered |
| Date/Time Start of Administration | 01/15/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Not Administered |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| vaccine type | Hep A, pediatric, unspecified formulation |
| Diseases with serological evidence of immunity | Serology confirmed hepatitis A |
| Description |
|---|
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A VXU message is generated by the EHR. |
| Post-Condition |
|---|
The ACK Z23 is received by the EHR. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. |
| Evaluation Criteria |
|---|
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes |
|---|
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The provider identifies that the vaccine administration of Hepatitis B for this visit was documented in error. The vaccine was not administered during the visit but was inadvertently documented as administered. A delete notification for the Hepatitis B vaccination administered is transmitted to the Immunization Registry for Juan Marcel Marina. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
The vaccinations for the visit have been administered. The vaccination report (Z22) has been transmitted to the IIS, including the record of the Hepatitis B vaccination which was inadvertently documented as administered. . |
| Post-Condition |
|---|
The EHR has recorded that the hepatitis B vaccination was documented in error. Juan Marcel Marina's record is updated to reflect that the immunization was not given. The Delete notification for this vaccination has been transmitted to the Immunization Registry. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses. Support for delete functionality. |
| Evaluation Criteria |
|---|
Verify that EHR can correct the vaccination documented in error. Verify that the vaccination record for Juan Marcel Marina for the Hepatitis B vaccination given on the date of the test is marked as invalid. Verify that a valid Delete notification is transmitted to the Immunization Registry for this vaccination: The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
| Notes |
|---|
All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘). If the EHR or other clinical system is not supporting the Jurisdiction-specific eligibility code, then OBX observation for VFC-Eligibility may pass with notable exception using vaccine program eligibility as non-VFC Eligible and OBX observation for funding source using Private funding source. The message may fail to validate because the new Vaccine Program Eligibility code is not in the HL70064_IZ code set. This is expected behavior and the system may pass with notable exception. |
| Element | Data |
|---|---|
| Patient Name | Juan Marcel Marina |
| Mother's Maiden Name | Anita Morales |
| ID Number | 123456 987633 |
| Date/Time of Birth | 03/04/2020 11:00 |
| Administrative Sex | Male |
| Patient Address | 4623 Standish Way Stamford CT 06903 USA |
| Local Number | (203)555-1213 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 03/04/2020 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 03/04/2020 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 03/04/2020 |
| Element | Data |
|---|---|
| Name | Manuel Marcel Marina |
| Relationship | Father |
| Address | 4623 Standish Way Stamford CT 06903 |
| Phone Number | (203)555-1213 |
| Element | Data |
|---|---|
| Administered Vaccine | Hepatitis B |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6332FK26 |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Delete |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Date vaccine information statement presented | 10/31/2021 |
| Document Type | Hepatitis B Vaccine VIS |
| vaccine fund pgm elig cat | HEPB09- Privately Insured |
| Vaccine funding source | Public non-VFC |
| Description |
|---|
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A VXU message is generated by the EHR. |
| Post-Condition |
|---|
The ACK Z23 is received by the EHR. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. |
| Evaluation Criteria |
|---|
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes |
|---|
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
| Comments |
|---|
| Pre-condition |
|---|
| Post-Condition |
|---|
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Notes |
|---|
| Description |
|---|
The EHR generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariela Gonzales. Querying the registry will consist of the vendor creating Z44 messages for Juana Mariela Gonzales to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity. Using the Z42 Response to Immunization Registry Query, the EHR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry and create a new forecast after reconciling the information. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juana Mariela Gonzales is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the Juana Mariela Gonzales Initial Data Load'. |
| Post-Condition |
|---|
A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned. |
| Test Objectives |
|---|
Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.
Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
Juana Mariela Gonzales is selected as the patient and her record is opened in the EHR. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juana Mariela Gonzales Initial Data Load completed. |
| Post-Condition |
|---|
Juana Mariela Gonzales is the active working patient in the EHR. |
| Test Objectives |
|---|
Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Tester shall verify that the product can distinguish Juana Mariela Gonzales from similar sounding names and her twin using all of the pediatric demographics:
|
| Notes |
|---|
Patient last name from the hospital returned by the IIS is Morales (the mother's maiden name). The patient last name in the EHR should be Gonzales. This test verifies that the EHR can match the returned record despite the different last name. |
| Description |
|---|
The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juana Mariela Gonzales Initial Data Load is completed. Juana Mariela Gonzales is the active working patient in the EHR. |
| Post-Condition |
|---|
The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariela Gonzales. |
| Test Objectives |
|---|
Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). |
| Evaluation Criteria |
|---|
Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission. Tester shall verify that the data in the message corresponds to the data in the EHR and contains all test data attributes supplied. |
| Notes |
|---|
No Note |
| Element | Data |
|---|---|
| Patient Name | Juana Mariela Gonzales |
| Mother's Maiden Name | Morales |
| ID Number | |
| Date/Time of Birth | 10/01/2021 11:00 |
| Sex | Female |
| Patient Address | 3321 Standish Way Stamford CT 06903 USA |
| Patient Phone | (203)555-1214 |
| Birth Indicator | Yes |
| Birth Order | 1 |
| Description |
|---|
The physician accesses the record for Juana Mariela Gonzales and: - Accepts the single vaccine in the registry record into the EHR history. |
| Comments |
|---|
There is no reconciliation step as there are no historical immunizations in the EHR. All will be imported from the Z42 response. |
| Pre-condition |
|---|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import. |
| Post-Condition |
|---|
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariela Gonzales). |
| Test Objectives |
|---|
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry. |
| Evaluation Criteria |
|---|
1. The EHR displays the information returned from the Immunization Registry according to the Juror Document. 2. The user imports returned vaccinations as follows: a. Vaccinations Imported: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 10/1/2021. |
| Notes | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
If the EHR is unable to match and import the previous immunization record, they will need to add the following historical immunization manually:
|
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Query the Registry for Juana Mariela Gonzales | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Patient Identifier | ||
| ID Number | 123456 | |
| Assigning Authority | ||
| Namespace ID | MYEHR | |
| ID Type | MR | |
| Patient Identifier | ||
| ID Number | 987633 | |
| Assigning Authority | ||
| Namespace ID | MYIIS | |
| ID Type | SR | |
| Name | Juana Mariela Gonzales | |
| Date of Birth | 10/01/2021 | |
| Sex | Female | |
| Address 1 | ||
| Street | 3321 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | USA | |
| Address Type | L | |
| Mother's Maiden Name | Joanna Elena Morales | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||
| Evaluated Immunization History Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Entering Organization | Stamford Regional Hospital | |
| Vaccine Group | Hep B, unspecified formulation | |
| Vaccine Administered | Hepatitis B | |
| Refusal Reason | ||
| Date/Time Administration-Start | 10/01/2021 | |
| Date/Time Administration-End | 10/01/2021 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | IM | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | ||
| Administering Provider | ||
| Name | Susan Pike | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | SRH | |
| Street Address | 15 Atlantic Avenue | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||
| Immunization Forecast | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Vaccine Group | Hep B, unspecified formulation | |
| Vaccine Due Date | 10/31/2021 | |
| Earliest Date to Give | 10/31/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | DTaP, unspecified formulation | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Hib | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | IPV | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Pneumococcal Conjugate, unspecified formulation | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | rotavirus, unspecified formulation | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Due Date | 09/01/2022 | |
| Earliest Date to Give | 09/01/2022 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2023 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Hep A, unspecified formulation | |
| Vaccine Due Date | 10/01/2022 | |
| Earliest Date to Give | 10/01/2022 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2023 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | MMR | |
| Vaccine Due Date | 10/01/2022 | |
| Earliest Date to Give | 10/01/2022 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 04/01/2023 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Varicella | |
| Vaccine Due Date | 10/01/2022 | |
| Earliest Date to Give | 10/01/2022 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 04/01/2023 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Description |
|---|
The physician accesses the record for Juana Mariela Gonzales and: - Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EHR defined methods). |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
EHR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juana Mariela Gonzales). |
| Post-Condition |
|---|
A vaccine forecast based upon the imported vaccine history is available to the user. |
| Test Objectives |
|---|
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. |
| Evaluation Criteria | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history: 2. Verify that the EHR includes in the vaccine forecast:
|
| Notes |
|---|
NOTE: Influenza does not have an overdue date. For DTaP: Catch-up schedule at this age doesn't really have an overdue date; same with HiB; Jan 14, 2022 is latest date to start rotavirus so depends on the date of the test; For these younger children, the EHR may follow a more detailed schedule based on age at the time of the test. This will result in variation in the forecast for this patient depending upon the date the test is run. Tester should document the rotavirus forecast implemented by the vendor. While there is not an expected recommendation for the earliest date to give for influenza, this may appear in some EHR implementations. Tester should note if this is included. The due date must be in range for the date shown. Vaccine forecast dates may be plus or minus 10 days to accommodate differences in date handling. Further variation should be documented in the notable exceptions, but minimally each forecast vaccine must be present. Rotavirus not due after 14 weeks, so depending on when the test is run, this may be due or not due. |
| Description |
|---|
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juana Mariela Gonzales is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariela Gonzales Initial Data Load'. |
| Post-Condition |
|---|
Visit orders are entered in Juana Mariela Gonzales' record. |
| Test Objectives |
|---|
Supporting data for documenting contraindications (it could also trigger an alert as a locally configured alert rule) Modify Antigen Recommendations Based on Active Diagnoses: The EHR or other clinical software system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses. Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed. Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2101: Indicates that a contraindication effective date messaged in OBX-5 is in the future |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The triage nurse enters basic information on Juana Mariela Gonzales - she has a fever (Temperature of 100.8 degrees F). |
| Comments |
|---|
No comments |
| Pre-condition |
|---|
The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariela Gonzales. |
| Post-Condition |
|---|
The clinical record for Juana Mariela Gonzales indicates that she currently has a fever (temperature 100.8 degrees F). |
| Test Objectives |
|---|
Supporting data for documenting contraindications (it could also trigger an alert as a locally configured alert rule): Modify Antigen Recommendations Based on Active Diagnoses: The EHR or other clinical software system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses. |
| Evaluation Criteria | ||||||||
|---|---|---|---|---|---|---|---|---|
Evaluation Criteria: Vendor successfully records all clinical data provided with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:
|
| Notes |
|---|
No Note |
| Description |
|---|
The provider attempts to document vaccine deferral information for the immunization for Juana Mariela Gonzales. These data quality checks primarily relate to improving vaccine deferral information and associated observations that will be included when submitting data to the immunization registry. |
| Comments |
|---|
Evaluates EHR functions for verifying data quality of vaccine deferral data and associated observations used for reporting vaccinations to the immunization registry. There is no transaction associated with this test step. |
| Pre-condition |
|---|
Prior Immunization History loaded and reconciled from the Immunization Registry. Vaccine forecast is available in the EHR indicating 6 vaccines are due: Hepatitis B, DTaP, Hib, IPV, Pneumococcal conjugate (PCV13) and Rotavirus. |
| Post-Condition |
|---|
The EHR has alerted the provider for each of the vaccine deferral data quality checks verified for Juana Mariela Gonzales. |
| Test Objectives |
|---|
Data Quality Checks: The EHR or other clinical software integrate additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2101: Indicates that a contraindication effective date messaged in OBX-5 is in the future |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Evaluation Criteria: During the course of data entry for the variant information below, the EHR triggers the following data quality issues:
|
| Notes |
|---|
The full vaccination deferral details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step. |
| Description |
|---|
The physician accesses the record for Juana Mariela Gonzales and: - Enters a deferral for the vaccines due (Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus) due to medical reason, indicating low grade fever, and defers for 1 month. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Prior Immunization History loaded and reconciled from the Immunization Registry. Vaccine forecast is available in the EHR indicating 6 vaccines are due: Hepatitis B, DTaP, Hib, IPV, Pneumococcal conjugate (PCV13) and Rotavirus. |
| Post-Condition |
|---|
Vaccine deferral is recorded indicating the medical reason of low-grade fever. |
| Test Objectives |
|---|
Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed. |
| Evaluation Criteria | ||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:
|
| Notes |
|---|
The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical). |
| Description |
|---|
Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes deferrals for the vaccines that were due this visit indicating the medical reason. The report MAY send the immunizations that the EHR imported from the IIS. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
The vaccines for the visit have been deferred. |
| Post-Condition |
|---|
The IIS has received the vaccine information (Z22 message). |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
Following the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes the vaccine deferrals. The report MAY send the immunizations that the EHR imported from the IIS. |
| Comments |
|---|
The Report must include all vaccine deferrals recorded in the EHR in any order. The report may include the information imported from the IIS. |
| Pre-condition |
|---|
The vaccines for the visit have been administered. |
| Post-Condition |
|---|
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The message must contain all deferrals recorded in the EHR. Current Date is expected for the Non-Administration date and deferral date. |
| Notes |
|---|
All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘). |
| Element | Data |
|---|---|
| Patient Name | Juana Mariela Gonzales |
| Mother's Maiden Name | Joanna Morales |
| ID Number | 123456 987633 |
| Date/Time of Birth | 10/01/2021 11:00 |
| Administrative Sex | Female |
| Patient Address | 3321 Standish Way Stamford CT 06903 USA |
| Local Number | (203)555-1214 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | Yes |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 10/01/2021 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 10/01/2021 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 10/01/2021 |
| Element | Data |
|---|---|
| Name | Joanna Elena Gonzales |
| Relationship | Mother |
| Address | 3321 Standish Way Stamford CT 06903 |
| Phone Number | (203)555-1214 |
| Element | Data |
|---|---|
| Administered Vaccine | Hepatitis B |
| Date/Time Start of Administration | 10/01/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Susan Pike |
| Substance Lot Number | 6332FK34 |
| Substance Expiration Date | 12/31/2021 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Stamford Regional Hospital |
| Entered By | Susan Pike |
| Ordered By | Justin Parker |
| Element | Data |
|---|---|
| Administered Vaccine | No vaccine administered |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Not Administered |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| vaccine type | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 10/31/2021 |
| Vaccination temporary contraindication/precaution expiration date | 11/30/2021 |
| Element | Data |
|---|---|
| Administered Vaccine | No vaccine administered |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Not Administered |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| vaccine type | DTaP |
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 10/31/2021 |
| Vaccination temporary contraindication/precaution expiration date | 11/30/2021 |
| Element | Data |
|---|---|
| Administered Vaccine | No vaccine administered |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Not Administered |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| vaccine type | Hib |
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 10/31/2021 |
| Vaccination temporary contraindication/precaution expiration date | 11/30/2021 |
| Element | Data |
|---|---|
| Administered Vaccine | No vaccine administered |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Not Administered |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| vaccine type | IPV |
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 10/31/2021 |
| Vaccination temporary contraindication/precaution expiration date | 11/30/2021 |
| Element | Data |
|---|---|
| Administered Vaccine | No vaccine administered |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Not Administered |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| vaccine type | Pneumococcal conjugate (PCV13) |
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 10/31/2021 |
| Vaccination temporary contraindication/precaution expiration date | 11/30/2021 |
| Element | Data |
|---|---|
| Administered Vaccine | No vaccine administered |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Not Administered |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| vaccine type | Rotavirus |
| Vaccination contraindication | current fever with moderate-to-severe illness |
| Vaccination contraindication/precaution effective date | 10/31/2021 |
| Vaccination temporary contraindication/precaution expiration date | 11/30/2021 |
| Description |
|---|
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A VXU message is generated by the EHR. |
| Post-Condition |
|---|
The ACK Z23 is received by the EHR. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. |
| Evaluation Criteria |
|---|
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes |
|---|
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
| Comments |
|---|
| Pre-condition |
|---|
| Post-Condition |
|---|
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Notes |
|---|
| Description |
|---|
The EHR generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Maria Gonzales. Querying the registry will consist of the vendor creating Z44 messages for Juana Maria Gonzales to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity. Using the Z42 Response to Immunization Registry Query, the EHR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry and create a new forecast after reconciling the information. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juana Mariela Gonzales is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the Juana Mariela Gonzales Initial Data Load. |
| Post-Condition |
|---|
A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned. |
| Test Objectives |
|---|
Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.
Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
Juana Maria Gonzales is selected as the patient and her record is opened in the EHR. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juana Maria Gonzales Initial Data Load completed. |
| Post-Condition |
|---|
Juana Maria Gonzales is the active working patient in the EHR. |
| Test Objectives |
|---|
Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Tester shall verify that the product can distinguish Juana Maria Gonzales from similar sounding names and her twin using all of the pediatric demographics:
|
| Notes |
|---|
No Note |
| Description |
|---|
The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry. This query will result in an error that too many matches are found. |
| Comments |
|---|
While the query is identical, the response to this step will be that no persons are found. No demographic changes are requested for this step as the error trigger is specific to the test step. |
| Pre-condition |
|---|
Juana Maria Gonzales Initial Data Load is completed. Juana Maria Gonzales is the active working patient in the EHR. |
| Post-Condition |
|---|
The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales. |
| Test Objectives |
|---|
Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). Setup step to test error handling: Test the capability of the EHR to process a response message that returns no persons found and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission. Tester shall verify that the data in the message corresponds to the data in the EHR and contains all test data attributes supplied. |
| Notes |
|---|
No Note |
| Element | Data |
|---|---|
| Patient Name | Juana Maria Gonzales |
| Mother's Maiden Name | Morales |
| ID Number | 123456 |
| Date/Time of Birth | 10/01/2021 11:15 |
| Sex | Female |
| Patient Address | 3321 Standish Way Stamford CT 06903 USA |
| Patient Phone | (203)555-1214 |
| Birth Indicator | Yes |
| Birth Order | 2 |
| Description |
|---|
The EHR processes notifies the user that there were too many matches found in response to the query the Immunization Registry for an Evaluated History and Forecast. |
| Comments |
|---|
The sending (querying) system will need to accept a response indicating that too many matches were found. |
| Pre-condition |
|---|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import. |
| Post-Condition |
|---|
The Immunization Registry responds with a message is indicating too many matches are found. The EHR has notified the user. |
| Test Objectives |
|---|
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry. Tests error handling: Test the capability of the EHR to process a response message that returns too many matches found and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
The tester verifies that the user/clinician is notified of no match. The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query. |
| Notes |
|---|
No Note |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry. This query will result in an error that no persons are found. |
| Comments |
|---|
This step is a repeat of Step 2: Query Registry for vaccination history and forecast for Juana Maria Gonzales in order to set up the error-checking response for 'No Persons Found'. While the query is identical, the response to this step will be that no persons are found. No demographic changes are requested for this step as the error trigger is specific to the test step. |
| Pre-condition |
|---|
Juana Maria Gonzales Initial Data Load is completed. Juana Maria Gonzales is the active working patient in the EHR. |
| Post-Condition |
|---|
The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales. |
| Test Objectives |
|---|
Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). Tests error handling: Test the capability of the EHR to process a response message that returns no persons found and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
Tester verifies that the message has been created and submitted in the test plan to trigger the error handling response in the next step. |
| Notes |
|---|
Query step is the same as Step 2: Query Registry for vaccination history and forecast for Juana Maria Gonzales. No new requirements tested. |
| Element | Data |
|---|---|
| Patient Name | Juana Maria Gonzales |
| Mother's Maiden Name | Morales |
| ID Number | 123456 |
| Date/Time of Birth | 10/01/2021 11:15 |
| Sex | Female |
| Patient Address | 3321 Standish Way Stamford CT 06903 USA |
| Patient Phone | (203)555-1214 |
| Birth Indicator | Yes |
| Birth Order | 2 |
| Description |
|---|
The EHR processes notifies the user that there were no persons found in response to the query the Immunization Registry for an Evaluated History and Forecast. |
| Comments |
|---|
The sending (querying) system will need to accept a response indicating that no matches were found. |
| Pre-condition |
|---|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import. |
| Post-Condition |
|---|
The Immunization Registry responds with a message is indicating no person record is found. The EHR has notified the user. |
| Test Objectives |
|---|
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry. Tests error handling: Test the capability of the EHR to process a response message that returns no persons found and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
The tester verifies that the user/clinician is notified of no match. The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query. |
| Notes |
|---|
No Note |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry. |
| Comments |
|---|
This step is a repeat of Step 2: Query Registry for vaccination history and forecast for Juana Maria Gonzales in order to set up the response for the history and forecast that will be imported in the following step. |
| Pre-condition |
|---|
Juana Maria Gonzales Initial Data Load is completed. Juana Maria Gonzales is the active working patient in the EHR. |
| Post-Condition |
|---|
The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales. |
| Test Objectives |
|---|
Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). |
| Evaluation Criteria |
|---|
Tester verifies that the message has been created and submitted in the test plan to trigger the error handling response in the next step. |
| Notes |
|---|
Query step is the same as Step 2: Query Registry for vaccination history and forecast for Juana Maria Gonzales. No new requirements tested. |
| Element | Data |
|---|---|
| Patient Name | Juana Maria Gonzales |
| Mother's Maiden Name | Morales |
| ID Number | 123456 |
| Date/Time of Birth | 10/01/2021 11:15 |
| Sex | Female |
| Patient Address | 3321 Standish Way Stamford CT 06903 USA |
| Patient Phone | (203)555-1214 |
| Birth Indicator | Yes |
| Birth Order | 2 |
| Description |
|---|
The physician accesses the record for Juana Maria Gonzales and: - Accepts the single vaccine in the registry record into the EHR history. |
| Comments |
|---|
There is no reconciliation step as there are no historical immunizations in the EHR. All will be imported from the Z42 response. |
| Pre-condition |
|---|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import. |
| Post-Condition |
|---|
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Maria Gonzales). |
| Test Objectives |
|---|
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry. |
| Evaluation Criteria | |
|---|---|
1. The EHR displays the information returned from the Immunization Registry according to the Juror Document. 2. The user imports the vaccination given and the date administered returned from the immunization registry as follows: a. Vaccinations Imported:
|
| Notes | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The message returns 'BG2' in the first name of the patient as the first immunization was given at the time of birth before the patient's first name was selected. The EHR should be able to import this record into the patient record despite the apparent name mismatch retaining the original name, Juana Maria Gonzales. If the EHR is unable to match and import the previous immunization record, they will need to add the following historical immunization manually. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:
|
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Query the Registry for Juana Maria Gonzales | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Patient Identifier | ||
| ID Number | 123456 | |
| Assigning Authority | ||
| Namespace ID | MYEHR | |
| ID Type | MR | |
| Patient Identifier | ||
| ID Number | 987633 | |
| Assigning Authority | ||
| Namespace ID | MYIIS | |
| ID Type | SR | |
| Name | BG2 Morales | |
| Date of Birth | 10/01/2021 | |
| Sex | Female | |
| Address 1 | ||
| Street | 3321 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | USA | |
| Address Type | L | |
| Mother's Maiden Name | Joanna Elena Morales | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||
| Evaluated Immunization History Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Entering Organization | Stamford Regional Hospital | |
| Vaccine Group | Hep B, unspecified formulation | |
| Vaccine Administered | Hepatitis B | |
| Refusal Reason | ||
| Date/Time Administration-Start | 10/01/2021 | |
| Date/Time Administration-End | 10/01/2021 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | IM | |
| Administration Site | Left Thigh | |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA | |
| Administration Notes | ||
| Administering Provider | ||
| Name | Susan Pike | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | SRH | |
| Street Address | 15 Atlantic Avenue | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | 1 | |
| Number of Doses in Series | 3 | |
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||
| Immunization Forecast | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Vaccine Group | Hep B, unspecified formulation | |
| Vaccine Due Date | 10/31/2021 | |
| Earliest Date to Give | 10/31/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | DTaP, unspecified formulation | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Hib | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | IPV | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Pneumococcal Conjugate, unspecified formulation | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | rotavirus, unspecified formulation | |
| Vaccine Due Date | 11/30/2021 | |
| Earliest Date to Give | 11/30/2021 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2022 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Due Date | 09/01/2022 | |
| Earliest Date to Give | 09/01/2022 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2023 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Hep A, unspecified formulation | |
| Vaccine Due Date | 10/01/2022 | |
| Earliest Date to Give | 10/01/2022 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 01/01/2023 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | MMR | |
| Vaccine Due Date | 10/01/2022 | |
| Earliest Date to Give | 10/01/2022 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 04/01/2023 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | Varicella | |
| Vaccine Due Date | 10/01/2022 | |
| Earliest Date to Give | 10/01/2022 | |
| Latest Date to Give | ||
| Date When Vaccine Overdue | 04/01/2023 | |
| Status in Immunization Series | ||
| Forecast Reason | ||
| Description |
|---|
The physician accesses the record for Juana Maria Gonzales and: - Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EHR defined methods). |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
The EHR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juana Maria Gonzales'). |
| Post-Condition |
|---|
A vaccine forecast based upon the imported vaccine history is available to the user. |
| Test Objectives |
|---|
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. |
| Evaluation Criteria | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history: 2. Verify that the EHR includes in the vaccine forecast:
|
| Notes |
|---|
NOTE: Influenza does not have an overdue date. For DTaP: catchup schedule at this age doesn't really have an overdue date; same with HiB; Jan 14, 2021 is latest date to start rotavirus so depends on the date of the test; For these younger children, the EHR may follow a more detailed schedule based on age at the time of the test. This will result in variation in the forecast for this patient depending upon the date the test is run. Tester should document the rotavirus forecast implemented by the vendor. While there is not an expected recommendation for the earliest date to give for influenza, this may appear in some EHR implementations. Tester should note if this is included. The due date must be in range for the date shown. Vaccine forecast dates may be plus or minus 10 days to accommodate differences in date handling. Further variation should be documented in the notable exceptions, but minimally each forecast vaccine must be present. |
| Description |
|---|
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Juana Maria Gonzales is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Maria Gonzales Initial Data Load'. |
| Post-Condition |
|---|
Visit orders are entered in Juana Maria Gonzales' record. |
| Test Objectives |
|---|
Supporting data for error handling tests. Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The nurse administers the DTaP-hepatitis B and poliovirus vaccine: - Documents all required information for the vaccine. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Prior Immunization History loaded and reconciled from the Immunization Registry. Vaccine forecast is available in the EHR indicating 6 vaccines are due: Hepatitis B, DtaP, Hib, IPV, Pneumococcal conjugate (PCV13) and Rotavirus. Order is placed for DTaP-hepatitis B and poliovirus vaccine. |
| Post-Condition |
|---|
The DTaP-hepatitis B and poliovirus vaccination is recorded in the EHR. |
| Test Objectives |
|---|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions. The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:
|
| Notes |
|---|
The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical). |
| Description |
|---|
Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report MAY send the immunizations that the EHR imported from the IIS. This transaction will result in an error or warning from the IIS. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
The vaccines for the visit have been administered. |
| Post-Condition |
|---|
The IIS has received the vaccine information (Z22 message) and issued a Z23 response with an error or warning. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.
Verify that the EHR is able to receive and display the error or warning response from the IIS.
Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
Following the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The report MAY send the immunizations that the EHR imported from the IIS. This will result in a warning from the IIS to assess the EHR ability to receive and display the error. |
| Comments |
|---|
The Report must include all vaccine deferrals recorded in the EHR in any order. The report may include the information imported from the IIS. |
| Pre-condition |
|---|
The vaccines for the visit have been administered. |
| Post-Condition |
|---|
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.
Setup to verify that the EHR is able to receive and display the error response from the IIS. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
| Notes |
|---|
The protection indicator for Juana Maria is 'Yes'. If this setting restricts the EHR from transmitting to the IIS, then the protection indicator for Juana Maria may be modified to 'No' for the purpose of this transaction. All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘). |
| Element | Data |
|---|---|
| Patient Name | Juana Maria Gonzales |
| Mother's Maiden Name | Joanna Morales |
| ID Number | 123456 987633 |
| Date/Time of Birth | 10/01/2021 11:15 |
| Administrative Sex | Female |
| Patient Address | 3321 Standish Way Stamford CT 06903 USA |
| Local Number | (203)555-1214 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | Yes |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 10/01/2021 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 10/01/2021 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 10/01/2021 |
| Element | Data |
|---|---|
| Name | Joanna Elena Gonzales |
| Relationship | Mother |
| Address | 3321 Standish Way Stamford CT 06903 |
| Phone Number | (203)555-1214 |
| Element | Data |
|---|---|
| Administered Vaccine | Hepatitis B |
| Date/Time Start of Administration | 10/01/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Susan Pike |
| Substance Lot Number | 6332FK34 |
| Substance Expiration Date | 12/31/2021 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Stamford Regional Hospital |
| Entered By | Susan Pike |
| Ordered By | Justin Parker |
| Element | Data |
|---|---|
| Administered Vaccine | DTaP-HepB-IPV |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6559FK32 |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Document Type | Multiple Vaccines VIS |
| VIS Presentation Date | 10/31/2021 |
| vaccine fund pgm elig cat | Not VFC eligible |
| Vaccine funding source | Private |
| Description |
|---|
The Immunization Registry returns a fatal error message indicating a table mapping error for the CVX code submitted was found during the course of filing the message. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A VXU message is generated by the EHR. |
| Post-Condition |
|---|
The ACK Z23 is received by the EHR. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.
Error Handling Support for a fatal error returned by the IIS, and the ability of the EHR to display a notification of this error to the user. |
| Evaluation Criteria |
|---|
The acknowledgement error message is consumed by the system responsible for the content of the administration message. The error returned is visible in the EHR. |
| Notes |
|---|
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
Following the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. This will result in multiple warnings from the IIS to assess the EHR ability to receive and display the error. |
| Comments |
|---|
The Report must include the newly administered vaccine recorded in the EHR. The report may include the information imported from the IIS. |
| Pre-condition |
|---|
The vaccines for the visit have been administered. |
| Post-Condition |
|---|
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.
Set up to verify that the EHR is able to receive and display the multiple warning response from the IIS. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
| Notes |
|---|
The protection indicator for Juana Maria is 'Yes'. If this setting restricts the EHR from transmitting to the IIS, then the protection indicator for Juana Maria may be modified to 'No' for the purpose of this transaction. All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘). |
| Element | Data |
|---|---|
| Patient Name | Juana Maria Gonzales |
| Mother's Maiden Name | Joanna Morales |
| ID Number | 123456 987633 |
| Date/Time of Birth | 10/01/2021 11:15 |
| Administrative Sex | Female |
| Patient Address | 3321 Standish Way Stamford CT 06903 USA |
| Local Number | (203)555-1214 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | Yes |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 10/01/2021 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 10/01/2021 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 10/01/2021 |
| Element | Data |
|---|---|
| Name | Joanna Elena Gonzales |
| Relationship | Mother |
| Address | 3321 Standish Way Stamford CT 06903 |
| Phone Number | (203)555-1214 |
| Element | Data |
|---|---|
| Administered Vaccine | Hepatitis B |
| Date/Time Start of Administration | 10/01/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Susan Pike |
| Substance Lot Number | 6332FK34 |
| Substance Expiration Date | 12/31/2021 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Stamford Regional Hospital |
| Entered By | Susan Pike |
| Ordered By | Justin Parker |
| Element | Data |
|---|---|
| Administered Vaccine | DTaP-HepB-IPV |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6559FK32 |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Document Type | Multiple Vaccines VIS |
| VIS Presentation Date | 10/31/2021 |
| vaccine fund pgm elig cat | Not VFC eligible |
| Vaccine funding source | Private |
| Description |
|---|
The Immunization Registry returns a warning message indicating an unrecognized administration site code submitted was found during the course of filing the message. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A VXU message is generated by the EHR. |
| Post-Condition |
|---|
The ACK Z23 is received by the EHR. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.
Error Handling Support for a warning returned by the IIS, and the ability of the EHR to display a notification of this warning to the user. |
| Evaluation Criteria |
|---|
The acknowledgement warning message is consumed by the system responsible for the content of the administration message. The warning returned is visible in the EHR. |
| Notes |
|---|
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
Following the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. This will result in multiple warnings from the IIS to assess the EHR ability to receive and display the warnings. |
| Comments |
|---|
The Report must include the newly administered vaccine recorded in the EHR. The report may include the information imported from the IIS. |
| Pre-condition |
|---|
The vaccines for the visit have been administered. |
| Post-Condition |
|---|
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.
Set up to verify that the EHR is able to receive and display the multiple warning response from the IIS. Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
| Notes |
|---|
The protection indicator for Juana Maria is 'Yes'. If this setting restricts the EHR from transmitting to the IIS, then the protection indicator for Juana Maria may be modified to 'No' for the purpose of this transaction. All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘). |
| Element | Data |
|---|---|
| Patient Name | Juana Maria Gonzales |
| Mother's Maiden Name | Joanna Morales |
| ID Number | 123456 987633 |
| Date/Time of Birth | 10/01/2021 11:15 |
| Administrative Sex | Female |
| Patient Address | 3321 Standish Way Stamford CT 06903 USA |
| Local Number | (203)555-1214 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | Yes |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 10/01/2021 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 10/01/2021 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 10/01/2021 |
| Element | Data |
|---|---|
| Name | Joanna Elena Gonzales |
| Relationship | Mother |
| Address | 3321 Standish Way Stamford CT 06903 |
| Phone Number | (203)555-1214 |
| Element | Data |
|---|---|
| Administered Vaccine | Hepatitis B |
| Date/Time Start of Administration | 10/01/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Susan Pike |
| Substance Lot Number | 6332FK34 |
| Substance Expiration Date | 12/31/2021 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | Stamford Regional Hospital |
| Entered By | Susan Pike |
| Ordered By | Justin Parker |
| Element | Data |
|---|---|
| Administered Vaccine | DTaP-HepB-IPV |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6559FK32 |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Document Type | Multiple Vaccines VIS |
| VIS Presentation Date | 10/31/2021 |
| vaccine fund pgm elig cat | Not VFC eligible |
| Vaccine funding source | Private |
| Description |
|---|
The Immunization Registry returns a message with multiple warnings indicating unrecognized administration site codes submitted were found during the course of filing the message. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A VXU message is generated by the EHR. |
| Post-Condition |
|---|
The ACK Z23 is received by the EHR. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.
Error Handling Support for multiple warnings returned by the IIS, and the ability of the EHR to display a notification of these warnings to the user. |
| Evaluation Criteria |
|---|
The acknowledgement warning message is consumed by the system responsible for the content of the administration message. The multiple warnings returned is visible in the EHR. |
| Notes |
|---|
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
| Comments |
|---|
| Pre-condition |
|---|
| Post-Condition |
|---|
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Notes |
|---|
| Description |
|---|
The provider periodically uses the EHR to identify the cohort of patients that are due or overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. The vaccine forecast is available to the EHR. |
| Post-Condition |
|---|
The Cohort report for all patients that are due or overdue for immunizations is available to the provider through the EHR. |
| Test Objectives |
|---|
Produce Population-Level Report: The EHR or other clinical software system generates aggregate, population-level reports based on known patient immunization data. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The provider periodically uses the EHR to identify the cohort of patients that are due or overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. The vaccine forecast is available to the EHR. Vaccines administered throughout this test plan. |
| Post-Condition |
|---|
The Cohort report for all patients that are due or overdue for immunizations is available to the provider through the EHR for Vaccines administered throughout this test plan. |
| Test Objectives |
|---|
Produce Population-Level Report: The EHR or other clinical software system generates aggregate, population-level reports based on known patient immunization data. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The following patient information is provided on the cohort report:
|
| Notes |
|---|
The vaccines due for the infants, in particular, may vary depending upon when the test is run as they may be subject to variation in the due dates as part of a catch-up schedule. Tester should document any such variances. Vaccines due for adult patient, Anita Francesca Marina are not required to be included in this report. |
| Description |
|---|
The EHR has received acknowledgment errors for vaccinations submitted to the IIS. The provider staff uses the EHR to generate an Acknowledgment Error Report or to export the information for use in a reporting tool. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
The EHR or other clinical software system has received acknowledgement errors from an IIS. |
| Post-Condition |
|---|
An acknowledgement report is generated from the EHR or other clinical software system or the report data has been exported to a reporting tool. |
| Test Objectives |
|---|
Acknowledgment Data Reporting: The EHR or other clinical software system is able to generate an Aggregate Error Report using the acknowledgment error message data returned in the ACK response to a vaccine update message (VXU/Z22). The report data must include the following data elements:
The aggregate report functionality should include grouping and sorting by error code, clinic, and vaccination date. Drill-down capability by error or date should also be supported as it is important to support identifying the source of the data errors and to correct the issue. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The provider has received acknowledgment errors for vaccinations submitted to the IIS. The provider staff uses the EHR to generate an Acknowledgment Error Report or to export the information for use in a reporting tool |
| Comments |
|---|
In addition to the acknowledgement data received during the course of this test plan, additional acknowledgement errors are provided in this test step. |
| Pre-condition |
|---|
The EHR or other clinical software system has received acknowledgement errors from an IIS. |
| Post-Condition |
|---|
An acknowledgement report is generated from the EHR or other clinical software system or the report data has been exported to a reporting tool. |
| Test Objectives |
|---|
Acknowledgment Data Reporting: The EHR or other clinical software system is able to generate an Aggregate Error Report using the acknowledgment error message data returned in the ACK response to a vaccine update message (VXU/Z22). The report data must include the following data elements:
The aggregate report functionality should include grouping and sorting by error code, clinic, and vaccination date. Drill-down capability by error or date should also be supported as it is important to support identifying the source of the data errors and to correct the issue. |
| Evaluation Criteria |
|---|
The EHR or other clinical software is able to generate an Aggregate Error Report using the acknowledgement error message data returned in the ACK response to a vaccine update message (VXU/Z22). The export data must include the following data elements:
The aggregate report functionality should include grouping and sorting by error code, clinic, vaccination date, and vaccine type. Drill-down capability by error or date should also be supported as it is important to support identifying the source of the data errors and to correct the issue. This functionality may be accomplished either by leveraging reporting functionality to produce an Aggregate Error Report provided by the EMR or other clinical software system or, as an alternative to the creation of an Aggregate Error Report, the EHR or other clinical software system have the option to allow ACK data to be exported as described in the IIP Aggregate Immunization Acknowledgment Message Reports Guidance White Paper1: Software developers who do not intend to incorporate aggregate acknowledgment report functionality must be able to support ACK data export functionality. This allows ACK messages received from an IIS to be downloaded in a common electronic format, including raw HL7, which can also be accessed by data analysts and/or third-party tools. The export functionality should allow the user to select a specified period and could have additional filtering capabilities. |
| Notes |
|---|
Developers should note which requirement is selected and need not demonstrate both requirements (capabilities). Whichever requirement is selected will be noted if a product achieves IIP recognition. For the 2021-2022 year this capability is considered “discovery” and is not required. Developers will be requested to walk through desktop testing to identify current or prospective approaches. They will demonstrate the capability if the functionality exists. The HIMSS IIP observer will record the process to evaluate whether this capability should be included in future testing. |
| Description |
|---|
| Comments |
|---|
| Pre-condition |
|---|
| Post-Condition |
|---|
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Notes |
|---|
| Description |
|---|
The EHR is used to identify patients that are high-priority candidates for a new adult vaccine campaign due to their status as a healthcare worker. The EHR is used to notify patients. Anita Francesca Marina is one of these candidates. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Anita Francesca Marina is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Social History Data according to the steps in the Anita Francesca Marina Initial Data Load. |
| Post-Condition |
|---|
Anita has received notification of the vaccine eligibility. |
| Test Objectives |
|---|
Notify Patients of Immunization Status: The EHR or other clinical software provides the ability to notify patients of recommendations based on their individual preferences for receiving notification. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The provider is able to use the EHR to identify the cohort of patients that work in the healthcare industry that are prioritized for a newly available vaccine. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Adult patient data load completed with demographic data, vaccination history, and social history. Historical Vaccination reconciled and loaded into the EHR. |
| Post-Condition |
|---|
The list of patients that work in the healthcare industry are identified as candidates for the new vaccine campaign. |
| Test Objectives |
|---|
Notify Patients of Immunization Status: The EHR or other clinical software provides the ability to notify patients of recommendations based on their individual preferences for receiving notification. |
| Evaluation Criteria | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR identifies the following patients with documented occupation/industry information that indicate that they work in healthcare, and sends notification that they are a candidate for the new vaccine using their established preferred contact method, for those that have agreed to be contacted per the Publicity Code recorded for the patient.
|
| Notes |
|---|
If the EHR is not able to select based on Occupation or Industry, they may select by employer. The tester will document any variation needed to establish this notification. If there are additional patients in the EHR database that are healthcare workers, they may also appear in this list. |
| Description |
|---|
The EHR allows the provider to select the patients that will be seen in the clinic for the day. Anita Francesca Marina is one of these patients, and a query will be sent to the registry to retrieve her vaccine history. Querying the registry will consist of the vendor creating a Z44 message for Anita Francesca Marina.
Using the Z42 Response to Immunization Registry Query, the EHR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry. This test will also look at the system's ability to view the vaccine recommendation returned by the registry and create a new recommendation after reconciling the information. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Anita Francesca Marina is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the Anita Francesca Marina Initial Data Load. |
| Post-Condition |
|---|
A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned. |
| Test Objectives |
|---|
Select One or More Patients: The EHR or other clinical software system must allow a provider to specify one or more patients in real time or those scheduled for appointment(s) in the future (e.g., the next day, week, month, etc.) so that a request can be sent to the public health immunization registry for each patient’s complete immunization history. Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules. Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry. View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. Review Patient Immunization History: The EHR or other clinical software system displays vaccine history by vaccine series. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The EHR allows the provider to select the patients that will be seen in the clinic for the day. Anita Francesca Marina is selected as the patient from this list and her record is opened in the EHR |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Anita Francesca Marina and Juan Marcel Marina Initial Data Load completed. |
| Post-Condition |
|---|
The set of patients that will be seen in the clinic for the day are selected and available for additional actions (e.g. query the registry). Anita Francesca Marina is selected as the active working patient in the EHR. |
| Test Objectives |
|---|
Select One or More Patients: The EHR or other clinical software system must allow a provider to specify one or more patients in real time or those scheduled for appointment(s) in the future (e.g., the next day, week, month, etc.) so that a request can be sent to the public health immunization registry for each patient’s complete immunization history. |
| Evaluation Criteria |
|---|
Anita Francesca Marina and Juan Marcel Marina are scheduled to be seen in the clinic on the selected day (day of test). The EHR is able to select the list of patients scheduled to be seen on the day of the test. This list includes Anita Francesca Marina and Juan Marcel Marina. Anita Francesca Marina is selected from this list to proceed with the request for her vaccine history and recommendations. |
| Notes |
|---|
The list of patients requested to be scheduled for this test must include Anita Francesca Marina and Juan Marcel Marina, but if other patients are scheduled for the day they should also be listed. The co-located practices for Anita's PCP and Juan Marcel's pediatrician use the same system. |
| Description |
|---|
The provider uses the EHR to query the Immunization Registry for an Evaluated History and Vaccine Recommendations for an adult patient based on information known to the Immunization Registry. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Anita Francesca Marina Initial Data Load is completed. Anita Francesca Marina is the active working patient in the EHR. |
| Post-Condition |
|---|
The Immunization Registry responds with Evaluated Vaccine History and Forecast for adult patient, Anita Francesca Marina. |
| Test Objectives |
|---|
Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).
Note: Adult Patient |
| Evaluation Criteria |
|---|
Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission for the adult patient Anita Francesca Marina. Tester shall verify that the data in the message corresponds to the data in the EHR and contains all test data attributes supplied. |
| Notes |
|---|
The list of patients requested to be scheduled for this test must include Anita Francesca Marina and Juan Marcel Marina, but if other patients are scheduled for the day they should also be listed. |
| Element | Data |
|---|---|
| Patient Name | Anita Francesca Marina |
| Mother's Maiden Name | Ramirez |
| ID Number | 123456 |
| Date/Time of Birth | 06/01/1986 |
| Sex | Female |
| Patient Address | 4623 Standish Way Stamford CT 06903 USA |
| Patient Phone | (203)555-1213 |
| Birth Indicator | No |
| Birth Order |
| Description |
|---|
The physician accesses the record for adult patient Anita Francesca Marina and: - Accepts the vaccines provided by the registry as the complete vaccination history for this patient had not yet been recorded in the EHR. |
| Comments |
|---|
All historical vaccinations will be imported from the Z42 response. |
| Pre-condition |
|---|
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import. The provider has reviewed the patient-provided influenza vaccination and incorporated the vaccination information in the patient record. |
| Post-Condition |
|---|
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (adult patient Anita Francesca Marina). |
| Test Objectives |
|---|
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry. Review Patient Immunization History: The EHR or other clinical software system displays vaccine history by vaccine series.
Note: Adult Patient |
| Evaluation Criteria |
|---|
1. The EHR displays the information returned from the Immunization Registry according to the Juror Document. 2. The user imports all the vaccination given and the date administered returned from the immunization registry. a. Vaccinations Imported for adult patient: measles, mumps, rubella, and varicella virus vaccine (MMRV) (CVX 94) administered 6/1/2017. tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed (Adacel) (Tdap) (CVX 115) administered 6/1/2017. influenza, recombinant, quadrivalent, injectable, preservative free (CVX 185) administered 9/1/2020 Note: Not available from the registry (available only to the EHR): influenza, recombinant, quadrivalent, injectable, preservative free (CVX 185) administered 9/1/2021 Evidence of immunity to Hepatitis A is available from the EHR Evidence of non-immunity to Hepatitis B is available from the EHR |
| Notes |
|---|
No Note |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Query the Registry for Anita Francesca Marina | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Patient Identifier | ||
| ID Number | 123456 | |
| Assigning Authority | ||
| Namespace ID | MYEHR | |
| ID Type | MR | |
| Patient Identifier | ||
| ID Number | 987633 | |
| Assigning Authority | ||
| Namespace ID | MYIIS | |
| ID Type | SR | |
| Name | Anita Francesca Marina | |
| Date of Birth | 06/01/1986 | |
| Sex | Female | |
| Address 1 | ||
| Street | 4623 Standish Way | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06903 | |
| Country | USA | |
| Address Type | L | |
| Mother's Maiden Name | Sophia Serena Ramirez | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||
| Evaluated Immunization History Information | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Entering Organization | Metro Primary Care | |
| Vaccine Group | measles, mumps, rubella, and varicella virus vaccine | |
| Vaccine Administered | measles, mumps, rubella, and varicella virus vaccine | |
| Refusal Reason | ||
| Date/Time Administration-Start | 06/01/2017 | |
| Date/Time Administration-End | 06/01/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Merck and Co Inc | |
| Administration Notes | ||
| Administering Provider | ||
| Name | Jessica Mason | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | MPC | |
| Street Address | 400 Shoreline Drive | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | ||
| Number of Doses in Series | ||
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Metro Primary Care | |
| Vaccine Group | tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed | |
| Vaccine Administered | tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed | |
| Refusal Reason | ||
| Date/Time Administration-Start | 06/01/2017 | |
| Date/Time Administration-End | 06/01/2017 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | ||
| Administering Provider | ||
| Name | Jessica Mason | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | MPC | |
| Street Address | 400 Shoreline Drive | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | ||
| Number of Doses in Series | ||
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| Element Name | Data | Tester Comment |
| Entering Organization | Metro Primary Care | |
| Vaccine Group | influenza, recombinant, quadrivalent,injectable, preservative free | |
| Vaccine Administered | influenza, recombinant, quadrivalent,injectable, preservative free | |
| Refusal Reason | ||
| Date/Time Administration-Start | 09/01/2020 | |
| Date/Time Administration-End | 09/01/2020 | |
| Administered Amount | 0.5 | |
| Administered Units of Measure | mL | |
| Route of Administration | Intramuscular | |
| Administration Site | Left Deltoid | |
| Substance Manufacturer Name | Sanofi Pasteur | |
| Administration Notes | ||
| Administering Provider | ||
| Name | Jessica Mason | |
| ID Number | ||
| Administered-at Location | ||
| Facility ID | MPC | |
| Street Address | 400 Shoreline Drive | |
| Other Designation | ||
| City | Stamford | |
| State | CT | |
| Zip Code | 06901 | |
| Country | ||
| Valid Dose | YES | |
| Validity Reason | ||
| Completion Status* | Complete | |
| Dose Number in Series | ||
| Number of Doses in Series | ||
| Immunization Series Name | ||
| Status in Immunization Series | ||
| Immunization Schedule Used | ACIP | |
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||
| Immunization Forecast | ||
|---|---|---|
| Element Name | Data | Tester Comment |
| Vaccine Group | influenza, unspecified formulation | |
| Vaccine Due Date | 09/01/2021 | |
| Earliest Date to Give | ||
| Latest Date to Give | ||
| Date When Vaccine Overdue | ||
| Status in Immunization Series | ||
| Forecast Reason | ||
| Element Name | Data | Tester Comment |
| Vaccine Group | tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed | |
| Vaccine Due Date | 06/01/2022 | |
| Earliest Date to Give | ||
| Latest Date to Give | ||
| Date When Vaccine Overdue | ||
| Status in Immunization Series | ||
| Forecast Reason | ||
| Description |
|---|
The physician accesses the record for Anita Francesca Marina and: - Views the vaccine recommendations (as determined through EHR defined methods with consideration for both the IIS vaccine history and forecast and the information available through the EHR). As a healthcare worker: 1. The EHR or other clinical software system indicates that given her immunity status of negative for Hepatitis B, that she should receive the Hepatitis B vaccination. 2. Anita has been identified to receive a new vaccine as a campaign for healthcare workers. |
| Comments |
|---|
All historical vaccinations will be imported from the Z42 response. |
| Pre-condition |
|---|
EHR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for adult patient Anita Francesca Marina'). |
| Post-Condition |
|---|
Adult vaccine recommendations based upon the imported vaccine history and information already available to the provider is available to the user. |
| Test Objectives |
|---|
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations. Note: Recommendation for new vaccine; Vaccine Recommendation for Adult Patient |
| Evaluation Criteria | ||||||||
|---|---|---|---|---|---|---|---|---|
1. Tester verifies that the vendor can display the immunization recommendations based upon the adult patient's vaccination history, and risk factors of potential future pregnancy and as a healthcare worker. 2. Verify that the EHR includes in the vaccine recommendations:
|
| Notes |
|---|
Healthcare worker-related vaccine recommendations are not returned from the registry since the registry does not maintain employment information. Influenza does not have an overdue date. The due date must be in range for the date shown. Vaccine recommendation dates may vary and should accommodate differences in date handling. Further variation should be documented in the notable exceptions, but minimally each forecast recommendation must be present. |
| Description |
|---|
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Anita Francesca Marina is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Anita Francesca Marina Initial Data Load'. |
| Post-Condition |
|---|
Visit orders are entered in Anita Francesca Marina's record. |
| Test Objectives |
|---|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS. Note: New vaccine, adult Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2100: Indicates that any date field is in the future. Specific errors for date transmitted in an OBX are also provided. - 2102: Indicates that a VIS given date messaged in OBX-5 is in the future - 2103: Indicates that a VIS publication date messaged in OBX-5 is in the future - 2013: Indicates that the funding source code in an OBX segment conflicts with other data in the message (eligibility, age etc) - 2017: Indicates that the administration site is inconsistent with the vaccine administered |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The provider attempts to document vaccine administration information for the immunization for Anita Francesca Marina. These data quality checks primarily relate to improving vaccine administration information and associated observations that will be included when submitting data to the immunization registry. |
| Comments |
|---|
Evaluates EHR functions for verifying data quality of vaccination data and associated observations used for reporting vaccinations to the immunization registry. There is no transaction associated with this test step. |
| Pre-condition |
|---|
Order is placed for the Hepatitis B vaccine. |
| Post-Condition |
|---|
The EHR has alerted the provider for each of the data quality checks verified for Anita Francesca Marina. |
| Test Objectives |
|---|
Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections. Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes: - 2100: Indicates that any date field is in the future. Specific errors for date transmitted in an OBX are also provided. - 2102: Indicates that a VIS given date messaged in OBX-5 is in the future - 2103: Indicates that a VIS publication date messaged in OBX-5 is in the future - 2013: Indicates that the funding source code in an OBX segment conflicts with other data in the message (eligibility, age etc) - 2017: Indicates that the administration site is inconsistent with the vaccine administered |
| Evaluation Criteria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Evaluation Criteria: During the course of data entry for information below, the EHR triggers the following data quality issues:
|
| Notes |
|---|
The full vaccination details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step. If a system does not allow the entry of a future date for the date/time of administration, VIS Publication Date or the VIS Given Date this is acceptable for the purposes of data quality. |
| Description |
|---|
Since Anita is a healthcare worker with no evidence of immunity to Hepatitis B, the nurse administers a Hepatitis B vaccination to adult patient, Anita Francesca Marina: - Documents all required information for the Hepatitis B vaccine |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Order is placed for the Hepatitis B vaccine. |
| Post-Condition |
|---|
The administration of the Hepatitis B vaccine is recorded in the EHR. |
| Test Objectives |
|---|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS. Note: Adult Patient |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR or other clinical software system records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions: The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:
|
| Notes |
|---|
The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical). |
| Description |
|---|
The nurse administers the new vaccine to adult patient, Anita Francesca Marina: - Documents all required information for the vaccine using the new vaccine information entered in the Manage Configuration test steps. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Order is placed for the newly available vaccine. |
| Post-Condition |
|---|
The administration of the newly available vaccine is recorded in the EHR. |
| Test Objectives |
|---|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine). Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS. Note: Adult Patient |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR or other clinical software system records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions: The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:
|
| Notes |
|---|
The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical). The VIS Publication Date is not yet formalized for this vaccine, so may differ in tested product. |
| Description |
|---|
Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EHR imported from the IIS. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
The vaccines for the visit have been administered. |
| Post-Condition |
|---|
The IIS has received the vaccine information (Z22 message). |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. Note: Adult Patient Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines, and an indication that Varicella was not administered due to a history of the disease as evidence of immunity. The Vaccination report also includes an indication that Hepatitis A was not administered due to serological evidence of immunity. The report MAY send the immunizations that the EHR imported from the IIS. |
| Comments |
|---|
The Report must include all newly administered vaccines in any order. The report may include the information imported from the IIS. |
| Pre-condition |
|---|
The vaccines for the visit have been administered. The clinical information has been documented for Anita Francesca Marina in the Initial Data Load. |
| Post-Condition |
|---|
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. Note: Adult Patient Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Note: Testing for NDC codes, CVX for immunizations. |
| Evaluation Criteria |
|---|
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. This includes indication that Hepatitis A was not administered due to serological evidence of immunity. |
| Notes |
|---|
All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘). |
| Element | Data |
|---|---|
| Patient Name | Anita Francesca Marina |
| Mother's Maiden Name | Sophia Ramirez |
| ID Number | 123456 987633 |
| Date/Time of Birth | 06/01/1986 |
| Administrative Sex | Female |
| Patient Address | 4623 Standish Way Stamford CT 06903 USA |
| Local Number | (203)555-1213 |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | No |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | Active |
| Immunization Registry Status Effective Date | 10/01/2012 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 10/01/2012 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 10/01/2012 |
| Element | Data |
|---|---|
| Administered Vaccine | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 06/01/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Jessica Mason |
| Substance Lot Number | 6552FK16 |
| Substance Expiration Date | 12/31/2017 |
| Substance Manufacturer Name | Merck and Co Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Metro Primary Care |
| Entered By | Jessica Mason |
| Ordered By | Shannon Price |
| Element | Data |
|---|---|
| Administered Vaccine | tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed |
| Date/Time Start of Administration | 06/01/2017 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Jessica Mason |
| Substance Lot Number | 6932FK14 |
| Substance Expiration Date | 12/31/2017 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Metro Primary Care |
| Entered By | Jessica Mason |
| Ordered By | Shannon Price |
| Element | Data |
|---|---|
| Administered Vaccine | influenza, recombinant, quadrivalent,injectable, preservative free |
| Date/Time Start of Administration | 09/01/2020 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Jessica Mason |
| Substance Lot Number | 6475FK21 |
| Substance Expiration Date | 12/31/2020 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Metro Primary Care |
| Entered By | Jessica Mason |
| Ordered By | Shannon Price |
| Element | Data |
|---|---|
| Administered Vaccine | influenza, recombinant, quadrivalent,injectable, preservative free |
| Date/Time Start of Administration | 09/01/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Sophia Muir |
| Substance Lot Number | 8L4B3423 |
| Substance Expiration Date | 12/31/2021 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | Metro Primary Care |
| Entered By | Jessica Mason |
| Ordered By | John Jobs |
| Element | Data |
|---|---|
| Administered Vaccine | Pfizer-BioNTech COVID-19 Vaccine |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Jessica Mason |
| Substance Lot Number | 8L7B3418 |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | Metro Primary Care |
| Entered By | Jessica Mason |
| Ordered By | Shannon Price |
| Element | Data |
|---|---|
| Document Type | COVID-19 Pfizer BioNTech EUA Recipient-Caregiver Fact Sheet-12 years and older |
| VIS Presentation Date | 10/31/2021 |
| vaccine fund pgm elig cat | Not VFC elig |
| Vaccine funding source | Public funds |
| Element | Data |
|---|---|
| Administered Vaccine | hepatitis B vaccine, adult dosage |
| Date/Time Start of Administration | 10/31/2021 |
| Administered Amount | 1 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | Jessica Mason |
| Substance Lot Number | 6942FL12 |
| Substance Expiration Date | 12/31/2022 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | Complete |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | Metro Primary Care |
| Entered By | Jessica Mason |
| Ordered By | Shannon Price |
| Element | Data |
|---|---|
| Document Type | Hepatitis B Vaccine VIS |
| VIS Presentation Date | 10/31/2021 |
| vaccine fund pgm elig cat | Not VFC elig |
| Vaccine funding source | Private funds |
| Element | Data |
|---|---|
| Administered Vaccine | No vaccine administered |
| Date/Time Start of Administration | 05/15/2017 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | Not Administered |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Metro Primary Care |
| Entered By | Jessica Mason |
| Ordered By | Shannon Price |
| Element | Data |
|---|---|
| vaccine type | hepatitis A vaccine, adult dosage |
| Diseases with serological evidence of immunity | Serology confirmed hepatitis A |
| Description |
|---|
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
A VXU message is generated by the EHR. |
| Post-Condition |
|---|
The ACK Z23 is received by the EHR. |
| Test Objectives |
|---|
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. |
| Evaluation Criteria |
|---|
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes |
|---|
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test. |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Description |
|---|
| Comments |
|---|
| Pre-condition |
|---|
| Post-Condition |
|---|
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Notes |
|---|
| Description |
|---|
The provider reviews the available inventory following vaccine administrations used during the day. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Vaccine inventory entered. Vaccines administered for Juana Mariana Vazquez, Juan Marcel Marina, Juana Maria Gonzales, and Anita Francesca Marina. |
| Post-Condition |
|---|
Available vaccine inventory displayed. |
| Test Objectives |
|---|
Update Vaccine Inventory from Patient Dosage Administration: The EHR or other clinical software system updates the vaccine inventory to ensure the correct count of remaining available vaccine inventory. |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The provider reviews the available inventory following vaccine administrations used during the day. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Vaccine inventory entered. Vaccines administered for Juana Mariana Vazquez, Juan Marcel Marina, Juana Maria Gonzales, and Anita Francesca Marina. |
| Post-Condition |
|---|
Available vaccine inventory displayed. |
| Test Objectives |
|---|
Update Vaccine Inventory from Patient Dosage Administration: The EHR or other clinical system updates the vaccine inventory to ensure the correct count of remaining available vaccine inventory. |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The EHR inventory shows (minimally): 1.
2.
3.
4.
5.
6.
7.
8.
|
| Notes |
|---|
A Unit of Use GTIN for FLUZONE QUADRIVALENT (NDC: 49281-0521-00) had not yet been assigned at the time this test plan was generated. A GTIN was generated for the purpose of this test according to GS1 standards and may be updated in the future should this be changed in IIS: NDC Lookup Crosswalk published by CDC. Because the Flu season may not align with the test plan execution, the most current Flu vaccine may not be present. |
| Description |
|---|
The provider periodically uses the EHR to review inventory of remaining stock. The report may be sorted by expiration date or funding source. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Vaccines administered in previous test steps have been deprecated from stock record. |
| Post-Condition |
|---|
The Cohort report for all inventory stock is available to the provider through the EHR, sorted by funding source and expiration date. |
| Test Objectives |
|---|
Produce Vaccine History Report: The EHR or other clinical software system generates inventory reports of remaining stock. The reports can be sorted by expiration date and source (e.g., private or guarantee program). |
| Evaluation Criteria |
|---|
Evaluation criteria is defined within each test step. |
| Notes |
|---|
No Note |
| Description |
|---|
The provider periodically uses the EHR to review the stock inventory sorted by the expiration date to inform orders for new vaccine stock. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Vaccines administered in previous test steps have been deprecated from stock record. |
| Post-Condition |
|---|
The Cohort report for all inventory stock is available to the provider through the EHR, sorted by expiration date. |
| Test Objectives |
|---|
Produce Vaccine History Report: The EHR or other clinical software software system generates inventory reports of remaining stock. The reports can be sorted by expiration date and source (e.g., private or guarantee program). |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The following information is (minimally) provided on the inventory report, sorted by expiration date: 1.
2.
3.
4.
5.
6.
7.
8.
|
| Notes |
|---|
A GTIN for FLUZONE QUADRIVALENT (NDC: 49281-0521-00) had not yet been assigned at the time this test plan was generated. A GTIN was generated for the purpose of this test according to GS1 standards and may be updated in the future should this be changed in IIS: NDC Lookup Crosswalk published by CDC. Because the Flu season may not align with the test plan execution, the most current Flu vaccine may not be present. |
| Description |
|---|
The provider periodically uses the EHR to review the stock inventory sorted by funding source to inform orders for new vaccine stock. |
| Comments |
|---|
No Comments |
| Pre-condition |
|---|
Initial Data Load completed with demographic data, vaccination history, and clinical history. Vaccines administered in previous test steps have been deprecated from stock record. |
| Post-Condition |
|---|
The Cohort report for all inventory stock is available to the provider through the EHR, sorted by funding source. |
| Test Objectives |
|---|
Produce Vaccine History Report: The EHR or other clinical software system generates inventory reports of remaining stock. The reports can be sorted by expiration date and source (e.g., private or guarantee program). |
| Evaluation Criteria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
The following information is (minimally) provided on the inventory report, sorted by funding source: 1.
2.
3.
4.
5.
6.
7.
8.
|
| Notes |
|---|
A GTIN for FLUZONE QUADRIVALENT (NDC: 49281-0521-00) had not yet been assigned at the time this test plan was generated. A GTIN was generated for the purpose of this test according to GS1 standards and may be updated in the future should this be changed in IIS: NDC Lookup Crosswalk published by CDC. Because the Flu season may not align with the test plan execution, the most current Flu vaccine may not be present. |